MANUAL    OP    DIET. 


BY  THE  SAME  AUTHOR. 


THE   INDIGESTIONS, 

OR  DISEASES  OF  THE  DIGESTIVE  ORGANS  FUNCTIONALLY  TREATED.  By  THOMAS 
KING  CHAMBERS,  M.D.  OXON.,  F.R.C.P.,  LOND.  Third  American  Edition  revised.  In  one 
handsome  octavo  volume  of  287  pages,  cloth,  $3.00. 


RESTORATIVE    MEDICINE. 

AN  HARVEIAN  ANNUAL  ORATION,  delivered  at  the  Royal  College  of  Physicians,  London, 
on  June  24th,  1871.    In  one  handsome  volume,  small  12mo. ;  cloth,  $1.00. 

In  this  little  book,  the  reader  will  recognize  the  same  independence  and  vigor  of  thought 
and  clearness  of  diction  which  characterize  the  works  of  the  distinguished  author.  This 
small  book  comprises  within  its  pages  a  collection  of  subjects,  medical  and  social,  which  will 
occupy  men's  thoughts,  and  awaken  discussion  for  many  years  to  come. — Brit,  and  For.  Medico- 
Chimrg.  Review,  January,  1872. 


r 


A  MANUAL 


OF 


DIET  IN  HEALTH  AND  DISEASE, 


BY 


THOMAS    KING    CHAMBERS, 

M.D.  OXON.,  F.R.C.P.,  LOND., 

HONORARY  PHYSICIAN  TO  H.R.H.  THE  PRINCE  OP  WALES,  CONSULTING  PHYSICIAN 

TO  ST.  MARY'S  AND  THE  LOCK  HOSPITALS,  LECTURER  ON  MEDICINE 

AT  ST.  MARY'S  SCHOOL,  CORRESPONDING  FELLOW  OP  THE 

ACADEMY  OF  MEDICINE,  NEW  YORK,  ETC. 


PHILADELPHIA: 

HENRY      C.      LEA. 

1875. 


SHERMAN  A  CO.,  PRINTERS, 
PHILADELPHIA. 


PREFACE. 


THE  aims  of  this  Handbook  are  purely  practical,  and  there- 
fore it  has  not  been  thought  right  to  increase  its  size  by  the 
addition  of  the  chemical,  botanical,  and  industrial  learning  which 
rapidly  collects  round  the  nucleus  of  every  article  interesting  as 
an  eatable.  Space  has  been  thus  gained  for  a  full  discussion  of 
many  matters  connecting  food  and  drink  with  the  daily  current 
of  social  life,  which  the  position  of  the  Author  as  a  practicing 
physician  has  led  him  to  believe  highly  important  to  the  present 
and  future  of  our  race. 

THOS.  K.  CHAMBERS. 

24  MOUNT  STREET,  GROSVENOR  SQUARE, 
January  1,  1876. 


y 


CONTENTS. 


PART  I. 


CHAPTER  PAGE 

I.     THEORIES  OF  DIETETICS,    ........  17 

II.     ON  THE  CHOICE  OF  FOOD,         .......  29 

III.  ON  THE  PREPARATION  or  FOOD, 87 

IV.  ON  DIGESTION,    .        .        . 101 

Y.     NUTRITION,          ..........  122 


PART  II. 

SPECIAL  DIETETICS   OF   HEALTH. 

I.  EEQIMEN  OF  INFANCY  AND  MOTHERHOOD,      ....  125 

II.  KEGIMEN  OF  CHILDHOOD  AND  YOUTH, 134 

III.  COMMERCIAL  LIFE, 140 

IV.  LITERARY  AND  PROFESSIONAL  LIFE, 144 

V.  Noxious  TRADES, 152 

VI.  ATHLETIC  TRAINING, 155 

VII.  HINTS  FOR  HEALTHY  TRAVELLERS, 169 

VIII.  EFFECTS  OF  CLIMATE, 175 

IX.  STARVATION,  POVERTY,  AND  FASTING, 184 

X.  THE  DECLINE  OF  LIFE,     . 197 

XI.  ALCOHOL, 200 


Vlll  CONTENTS. 


PAKT  III. 

DIETETICS   IN  SICKNESS. 

CHAPTER  PACK 

I.     DIETETICS  AND  REGIMEN  OF  ACUTE  FEVERS,         .        .        .  231 
II.     THE  DIET  AND  EEGIMEN  OF  CERTAIN  OTHER  INFLAMMATORY 

STATES, 245 

III.  THE  DIET  AND  REGIMEN  OF  WEAK  DIGESTION,    .        .        .  252 

IV.  GOUT  AND  RHEUMATISM, 261 

V.    GRAVEL,  STONE,  ALBUMINURIA,  AND  DIABETES,    .        .        .  270 

VI.    DEFICIENT  EVACUATION 278 

VII.     NERVE  DISORDERS, 282 

VIII.     SCROFULA,  RICKETS,  AND  CONSUMPTION 294 

IX.    DISEASE  OF  HEART  AND  ARTERIES, 301 


ALPHABETICAL  INDEX, 307 


DIET  AND  REGIMEN. 


I. 

GENERAL   DIETETICS. 


CHAPTER  I. 

THEORIES   OF   DIETETICS. 

WHAT  is  the  natural  food  of  man  ? 

Each  animal  in  a  state  of  nature  finds  substances  suited  for  its 
nutrition  ready  to  hand,  and  within  the  grasp  of  the  instruments 
he  possesses  for  their  acquisition.  And  these  substances  seem, 
generally,  the  most  proper  to  sustain  the  health  and  strength.  So 
that  it  has  been  not  irrationally  argued,  that  it  would  be  a  useful 
act  of  scientific  reasoning  to  infer  from  the  structure  of  the  human 
organs  what  kind  of  food  they  are  most  fitted  to  appropriate,  for 
this  would  probably  prove  most  conducive  to  physical  well-being. 

When,  in  pursuit  of  this  reasoning,  we  come  to  compare  man's 
form  with  that  of  other  mammalia,  his  prehensile  organs — his 
teeth,  his  jaws,  and  his  feet  and  his  nails — do  not  seem  to  fit  him 
for  grappling  with  any  of  the  difficulties  which  the  adoption  of 
special  kinds  of  food  prepared  by  nature  entails.  He  can  neither 
tear  his  prey  conveniently,  nor  crack  many  nuts,  nor  grub  roots, 
nor  graze.  His  digestive  viscera,  in  middle  life,  are  too  bulky 
and  heavy  to  qualify  him  for  the  rapid  movements  of  the  car- 
nivora;  and  they  are  not  long  enough  to  extract  nourishment  from 
raw  vegetables.  To  judge  by  form  and  structure,  alone,  the  natu- 
ral food  of  an  adult  man  must  be  pronounced  to  be  nothing. 

On  the  other  hand,  if  we  read  the  laws  of  man's  nature  by  the 

2 


18  GENERAL    DIETETICS. 

light  of  the  general  consent  of  the  individuals  of  his  race,  which 
is  the  wisest  course,1  we  shall  arrive  at  the  opposite  conclusion, 
that  his  food  is  everything  which  any  other  warm-blooded  animal 
can  use  as  nourishment.  If  we  try  to  construct  a  universal  diet- 
ary from  the  records  which  each  new  traveller  brings  home  of 
what  he  has  beheld  habitually  eaten,  we  shall  find  very  few  forms 
of  organic  matter,  capable  of  supporting  mammalian  life,  which 
are  not  appropriated  by  man  also  to  his  own  use.  By  selection 
and  preparation  he  contrives  to  remove  such  parts  and  such  quali- 
ties of  the  substances  presented  by  nature  as  are  noxious  to  him, 
and  to  improve  such  as  suit  his  purpose ;  so  that  as  finally  swal- 
lowed, they  are  more  wholesome  to  him  than  to  the  beasts  who  eat 
nothing  else.  These  lists  of  possible  eatables  are  most  interesting 
to  the  student  of  human  nature;  they  lead  to  inferences  as  to  the 
action  of  laws,  religions,  customs,  and  associations,  in  making  that 
abominable  to  one  race  which  is  most  highly  appreciated  by 
another,  and  they  are  an  important  part  of  the  arguments  of  those 
who  trace  political  events  and  national  character  to  physical  causes; 
but  they  are  not  suited  to  the  present  volume,  which  will  concern 
itself  with  the  action  on  individual  health  of  food  generally  acces- 
sible in  the  British  market.  Reference  may  be  occasionally  made 
to  a  more  extended  materia  alimentarla,  but  it  can  contribute  little 
to  the  main  arguments  proposed. 

The  power  by  virtue  of  which  man  becomes  so  truly  omnivor- 
ous is  habit.  He  can  gradually,  in  time,  accustom  himself  to  live 
on  anything  containing  nourishment,  provided  he  be  not  limited 
in  quantity,  nor  restricted  in  facilities  for  preparation.  The  in- 
ferior animals  could  do  the  sante  if  they  only  knew  how  to  set 
about  it ;  for  when  we  bring  our  reason  to  bear  on  their  lives,  we 
can  effect  what  at  first  sight  seem  most  radical  changes  in  their 
nature,  in  respect  of  food ;  and  we  can  even  induce  and  perpetu- 
ate hereditary  forms  of  body  suited  to  the  altered  circumstances 
we  have  brought  about.  Spallanzani  found  that  pigeons  may  be 
fed  on  flesh,  and  eagles  on  bread,  by  accustoming  them  to  it ;  the 
domestic  dog  grows  strong  on  biscuit,  and  often  suffers  in  health 
on  being  brought  back  to  his  native  food  ;  our  poultry  is  more 


1  "  Consensus  omnium  nationum  lex  naturae  putancla  est." — Cicero  de  Legi- 
biea,  i,  8. 


THEORIES    OF    DIETETICS.  19 

robust,  more  fertile,  and  apparently  happier,  for  being  supplied 
with  meat,  fat,  or  soup,  and  our  cats  have  accommodated  them- 
selves to  a  mixed  diet,  assimilating  their  form  to  that  of  herbivora, 
by  a  considerable  increase  in  the  length  of  their  bowels  over  those 
owned  by  their  cousins  of  the  mountains.  The  speechless  creatures 
have  not  the  wits  to  acquire  unaided  these  new  powers;  compulsory 
education  is  necessary ;  even  for  such  a  simple  process  as  learning 
to  eat  turnips,  the  lamb  requires  a  shepherd  to  stand  over  him 
and  forcibly  make  him  chew.  Man's  chief  bodily  strength  de- 
pends on  his  willingness  to  submit  to  the  pain  of  acquiring  habits, 
and  on  his  forcing  his  domestic  stock  to  submit  to  it,  for  the  sake 
of  a  future  advantage. 

The  solvent  actions  of  the  juices  of  the  intestinal  canal  on  food 
seem  to  be  the  same  in  quality  in  all  classes  of  animals,  and  to 
admit  of  modification  in  the  proportions  of  their  ingredients  ac- 
cording to  the  diet  adopted.  Under  vegetable  food  the  saliva 
becomes  more  copious,  under  meat  there  is  more  gastric  juice. 
The  bile  of  a  grazing  ox  is  more  watery  than  that  of  a  man ;  the 
bile  of  a  growing  boy  (who  can  digest  any  amount  of  meat)  was 
found  by  Gorup-Besanez1  to  contain  nearly  double  the  amount  of 
solid  contained  in  that  of  an  old  woman  (whose  age  would  dispose 
her  to  be  very  little  carnivorous). 

This  shows  the  importance  of  what  may  be  called  the  prepara- 
tory or  mechanical  parts  of  digestion.  The  digestive  solvents  can 
evidently  grow  equal  to  all  emergencies  of  the  chemical  acts  re- 
quired of  them,  and  the  differences  in  the  results  of  those  acts  must 
mainly  hang  on  the  mechanical  condition  of  the  substances  pre- 
sented to  them.  Fortunate  indeed  is  it  that  such  is  the  case,  for 
the  mechanical  condition  of  the  food  is  certainly  more  fully  in  our 
power,  and  more  easily  influenced  by  our  reason,  than  the  chemi- 
cal solvency  of  the  secretions.  We  can  choose,  according  to  its 
hardness,  softness,  and  other  external  qualities,  the  sort  of  victual 
we  put  in  our  mouths ;  we  can  prepare  it  with  art,  can  regulate 
its  bulk  and  the  period  of  taking  it;  while  the  muscles  which 
chew  it  and  swallow  it  are  almost  entirely  under  our  direction. 
But  it  is  only  very  indirectly  that  we  can  influence  the  saliva,  the 
gastric  and  pancreatic  juices,  and  the  bile. 

1  Untersuchungen  iiber  d.  Galle,  Erlangen,  1846.  The  relative  proportions 
of  solid  matter  were  17.19  per  cent,  as  against  9.13  per  cent. 


20  GENERAL    DIETETICS. 

Assuming,  then,  that  man  can  easily  accommodate  himself  to  a 
varied  and  mixed  diet — that  he  has,  as  a  matter  of  fact,  accom- 
modated himself  to  it — and  that,  therefore,  it  will  in  future,  as  in 
the  past,  best  suit  his  requirements — the  next  point  of  interest  is 
the  proportion  which  its  several  ingredients  should  bear  to  one 
another. 

Physiologists  have  pointed  out  that  in  the  preparation  made 
for  the  infant  at  its  entrance  into  life,  and  which  is  a  striking  in- 
stance to  the  faithful  mind  of  a  controlling  design  in  creation,  we 
have  a  typical  instance  of  what  the  All-wise  considered  a  suitable 
dietary.  Looking  to  its  qualitative  composition,  we  find  milk 
contains  alimentary  principles  capable  of  separating  themselves, 
and,  in  fact,  habitually  separated  for  economical  purposes,  some- 
what in  the  following  proportions : 

Water, 88  per  cent. 

Oleaginous  matter  (cream,  butter),  3         " 

Nitrogenous  matter  (cheese  and  albumen),      .       4         " 
Hydrocarbon  (sugar),      .         .         .         .  4J       " 

Saline  matter  (phosphate  of  lime,  chloride  of 

sodium,  iron,  etc.), £       " 

This  rough  average  is  the  best  way  of  stating  the  facts  for  phys- 
iological purposes;  since,  as  every  mother,  physician,  and  far- 
mer knows,  the  proportions  vary  considerably  in  different  speci- 
mens of  even  the  same  species  of  animal,  and  are  influenced  by 
differences  in  the  mode  of  living.  The  argument  is,  that  there 
or  thereabouts,  may  be  found  the  ratio  which  there  should  be  in 
our  dietary,  in  the  amounts  of  the  alimentary  substances  of  which 
the  above  may  be  taken  as  representatives.  That  is  to  say,  that, 
supposing  a  man  to  consume  200  ounces  of  victual  daily,  the  con- 
tents should  be  about — 

6  quarts  of  water, 

J  a  Ib.  of  animal  matter,  such  as  cheese,  or  lean  meat,  or  eggs, 

6  ozs.  of  fat,  oil,  or  butter, 

9  ozs.  of  sugar  or  starch, 

1  oz.  of  salt,  and  some  small  quantity  of  bone  or  iron. 

A  serious  flaw  in  this  argument  is  that  while  the  dietary  is  pre- 
pared for,  and  truly  suits  very  well,  the  newly  born,  we  have  no 
evidence  that  either  it  is  intended  for,  or  would  suit  better  than 


THEORIES    OF    DIETETICS. 


21 


another,  the  adult.  The  milk  of  our  domestic  animals  so  closely 
resembles  that  which  supported  us  in  infancy,  that  if  we  carried 
the  reasoning  out  to  its  logical  consequences,  we  should  all  be 
feeding  together  now  at  the  same  manger.  If  the  milk  represents 
what  the  adult  ought  to  make  his  diet,  our  bull  would  require 
only  a  little  more  butter,  and  our  horse  only  a  little  less  than  we 
do;  our  goat  would  want  one-third  more  meaty  or  nitrogenous 
matter  to  be  contained  in  the  food  than  ourselves;  and  the  dog 
would  require  five  times  the  proportion  of  flesh  that  is  laid  on  his 
master's  table  to  be  afforded  him.1  In  point  of  fact,  the  life  led 
by  the  young  of  all  animals  is  much  the  same,  whereas  in  adult 
age  they  differ  widely  in  their  occupations,  and  in  the  demand  for 
the  sort  of  viands  best  adapted  to  those  occupations. 

There  is  greater  promise  of  profit  to  the  dietician  in  a  calcula- 
tion of  the  outgoings  of  matters  resulting  from  the  wear  and  tear 
of  the  body,  reducing  these  to  ultimate  elementary  substances,  and 
thus  ascertaining  in  what  proportion  to  one  another  new  supplies 
of  ultimate  elementary  substances  are  required,  merely  to  replace 
those  consumed.  It  is  obvious  that  the  food  which  supplies  the 
demand  most  accurately  will  be  the  most  economical  in  the  highest 
sense.  "We  can  measure,  for  example,  the  carbon  and  the  nitro- 
gen daily  thrown  off  in  the  excretions,  and  then  lay  down  a  rule 
for  the  minimum  quantity  of  those  elements  which  the  daily  food 
must  contain  to  keep  up  the  standard  weight.  If  the  diet  is  such 
as  to  make  it  necessary  to  eat  too  much  carbon  in  order  to  secure 
a  due  amount  of  nitrogen,  there  is  an  obvious  waste,  and  the  di- 

1  The  computation  of  the  ingredients  of  milk  is  a  deduction  from  the  fol- 
lowing table  of  M.  Boussingault's  analysis: 


Milk  of 

Water, 
per  cent. 

Casein  and 
Albumen. 

Butter. 

Sugar  of 
Milk. 

Salts. 

Woman,      .     .     . 
Cow,  

88.9 
86.6 

3.9 
4.0 

2.6 
4.0 

4.3 

4.8 

0.1 
0  6 

Ass,        .... 

90.3 

1.9 

1.0 

6.4 

0  4 

Mare,      .... 
Goat,  

90.9 
84  9 

3.3 
6.0 

1.2 
4.2 

4.3 
4.4 

0.5 
0  5 

Sheep,     .... 

Dos,  . 

86.5 
77.9 

4.5 

15.8 

4.2 
5.1 

6.0 
4.1 

0.7 
1.0 

22  GENERAL    DIETETICS. 

gestive  viscera  are  burdened  with  a  useless  load.  The  same  reck- 
oning can  be  applied  to  the  lime,  sulphur,  phosphorus,  oxygen, 
and  hydrogen,  which  go  towards  building  up  and  renewing  the 
tissues  of  the  body.  The  dietary  must  contain  these,  or  the  body 
must  waste  away  by  the  unstayed  drain  of  destructive  assimila- 
tion; and  if  it  contains  any  notable  excess,  not  only  is  it  uneco- 
nomical, but  may  be  pernicious  to  the  health. 

Suppose,  for  instance,  a  gang  of  a  hundred  average  prisoners  to 
excrete  in  the  shape  of  breathed  air,  urine,  and  fseces,  daily  71 J  Ibs. 
of  carbon  and  4J  Ibs.  of  nitrogen,  which  is  pretty  nearly  the 
actual  amount  of  those  elements  contained  in  the  dried  solids  of 
the  secretions,  as  estimated  in  current  physiological  works.  Ni- 
trogen and  carbon  to  that  extent,  at  least,  must  be  both  supplied. 
Now,  if  you  fed  them  on  bread  and  water  alone,  it  would  require 
at  least  380  Ibs.  of  bread  daily  to  keep  them  alive  for  long;  for  it 
takes  that  weight  to  yield  the  4J  Ibs.  of  nitrogen  daily  excreted. 
But  in  380  J  Ibs.  of  bread  there  are  128|  Ibs.  of  carbon,  which  is 
57  Ibs.  above  the  needful  quantity  of  that  substance.1 

If,  on  the  other  hand,  you  replaced  the  bread  by  a  purely  ani- 
mal diet,  you  would  have  to  find  354  Ibs.  of  lean  meat  in  order 
to  give  them  the  needful  71 J  Ibs.  of  carbon ;  and  thus  there  would 
be  wasted  105  Ibs.  of  nitrogen  which  is  contained  in  the  meat, 
over  and  above  the  4^  Ibs.  really  required  to  prevent  loss  of 
weight.2 

In  the  former  case,  each  man  would  be  eating  about  4  Ibs.  of 
bread,  in  the  latter,  3J  Ibs.  of  meat  per  diem.  If  he  ate  less,  he 
would  lose  his  strength.  In  the  former  case,  there  would  be  a 
quantity  of  starch,  and  in  the  latter,  a  quantity  of  albuminous 
matter,  which  would  not  be  wanted  for  nutrition,  and  would 
burden  the  system  with  a  useless  mass  very  liable  to  decompose 
and  become  noxious. 


1  Dr.  Letheby's  Analysis  gives  8.1  per  cent,  of  nitrogenous  matter  to  bread 
(Lectures  on  Food,  p.  6).     Of  this  }  is  nitrogen;   Boussingault's  analysis  of 
gluten  giving  14.60  per  cent.  (Ann.  de  Chim.  et  Phys.,  Ixiii,  2*29).     M.  Payen 
makes  the  proportion  of  carbon  to  nitrogen  in  bread  as  30  to  1. 

2  The  proportion  of  nitrogen  to  carbon  in   albumen  is  as  1  to  3£  (15.5  to 
53.5  by  Mulder's  analysis,  quoted  in  Lehrnann's  Phys.  Chemie,  i,  343).     In 
red  meat  there  is  74  per  cent,  of  water  (ditto,  iii,  96). 


THEORIES    OF    DIETETICS.  23 

Now,  if  a  mixed  dietary  be  adopted,  200  Ibs.  of  bread  with 
56  Ibs.  of  meat  would  supply  all  that  is  required.  Besides  water, 

200  Ibs.  of  bread  contains     .     .     60  of  carbon  .     .     2  of  nitrogen. 
60       "       meat  (including  12J 
Ibs.  of  fat  upon  it),  ....     12         "  .     .     2±        " 

72  4\ 

Judged  by  the  above  standard,  it  will  be  clearly  seen  that  milk 
does  not  represent  a  typical  diet  for  an  adult  population,  the  ni- 
trogenous matter  being  in  considerable  excess  in  proportion  to 
the  carbonaceous.  This  is  suitable  to  the  young  animal,  whose 
main  duty  consists  in  growing,  that  is  in  appropriating  an  excess 
of  nitrogenous  matter  to  form  an  addition  to  the  body  daily,  but 
not  to  the  full-grown,  who  has  to  develop  force,  or  its  equiva- 
lent, heat,  by  the  combustion  of  carbon,  and  had  rather  not  go  on 
growing. 

Calculations  such  as  these,  applied  to  the  other  numerous, 
though  less  bulky  constituents  of  the  body,  are  invaluable.  They 
afford  a  basis  for  the  administration  of  food-supply  to  armies,  na- 
vies, prisons,  and  other  bodies  of  men  dependent  upon  us ;  they 
enable  us  to  detect  the  causes  of  wasteful  expenditure,  and  to 
distribute  limited  means  in  an  economical  fashion.  They  tell  us 
why  nations  which,  voluntarily  or  involuntarily,  become  depen- 
dent on  one  kind  of  food  for  subsistence  can  never  be  wealthy, 
for  they  devour  and  waste  their  substance  ;  and  they  teach  states- 
men how  to  avoid  those  ruinous  revolutions,  which,  as  has  been 
well  observed,  arise  more  often  from  want  of  food  than  from  want 
of  liberty. 

But  the  calculations  must  always  be  open  to  the  correction  of 
continuous  observation  and  experiment.  Chemical  analysis  is 
much  too  young  an  art  to  be  infallible,  and  hitherto  undetected 
substances  and  conditions  are,  year  by  year,  turning  up,  which 
modify  our  conclusions.  And  a  very  wide  margin  must  be  left 
for  unforeseen  contingencies,  and  a  discretionary  power  be  placed 
in  the  hands  of  individuals,  or  there  is  a  risk  lest  the  adminis- 
trator should  have  to  regret  making  too  precise  a  reckoning.  He 
whose  income  is  only  just  equal  to  his  expenditure,  is  always  on 
the  brink  of  insolvency. 

The  most  important  modification  required  to  be  made  arises 


24  GENERAL    DIETETICS. 

out  of  the  differences  of  work  demanded.  Men  may  languish  in 
solitary  prisons,  invalids  may  lie  bedridden,  paupers  may  wait  for 
better  times,  nations  may  idle  away  existence,  on  a  scale  of  food- 
supply  which  is  followed  by  death  from  starvation  when  work  is 
demanded.  How  shall  the  effect  of  physical  exertion  be  reckoned  ? 
Here  the  engineers  have  helped  us  with  their  precise  and  irrefrag- 
able science.  Joule  of  Manchester  analyzed,  about  thirty  years 
ago,  the  relation  which  the  heat  used  in  machinery,  as  a  source  of 
power,  bore  to  the  force  of  motion  thus  made  active.  He  found 
means  of  proving,  that  raising  the  temperature  of  a  pound  of 
•\vater  one  degree  Fahrenheit  was  exactly  equivalent  to  raising 
772  Ibs.  to  the  height  of  a  foot.  And,  conversely,  that  the  fall  of 
772  Ibs.  might  be  so  applied  as  to  heat  a  pound  of  Avater  one  de- 
gree Fahrenheit.  Thus,  the  mechanical  work  represented  in  the 
lifting  772  Ibs.  a  foot  high,  or  one  pound  772  feet  high,  forms  the 
"  dyna'mic  equivalent,"  the  measure  of  the  possible  strength,  of 
one  degree  of  temperature  as  marked  by  the  thermometer.  Phys- 
iologists seized  eagerly  on  the  opportunity  which  Joule's  demon- 
stration seemed  to  afford  them  of  estimating,  in  actual  numerals, 
the  relation  of  living  bodies  to  the  work  they  have  to  do.  So 
much  earth,  raised  on  an  embankment,  represents  so  much  heat 
developed  in  the  machinery,  living  or  dead,  muscle  or  steel,  gang 
of  laborers  or  steam-engine,  which  raised  it.  Both  muscle  and 
steel  come  equally  under  the  great  physical  laws  of  the  universe 
which  the  far-sighted  mechanician  has  expounded.  Now,  in  the 
animal  frame,  the  supply  of  heat,  and  therefore  the  supply  of  ca- 
pacity ibr  work,  is  that  which  is  developed  from  latency  into 
energy  by  the  chemical  actions,  the  ceaseless  round  of  unending 
change,,  which  is  an  inseparable  part  of  life.  The  amount  of  fully 
digested  food,  converted  through  several  stages  into  gaseous, 
liquid,  and  solid  excretory  matters,  produces  by  its  chemical 
changes  a  definite  amount  of  heat,  of  which  a  definite  amount  es- 
capes, and  a  definite  amount  is  employed  in  working  the  involun- 
tary machinery  of  the  body,  and  the  rest  is  available  for  conver- 
sion at  will  into  voluntary  muscular  action.  As  the  mechanician 
allows  for  the  effect  of  friction,  etc.,  in  making  his  calculations,  so 
the  physiologist  allows  for  the  action  of  diffusion,  conduction,  im- 
perfect secretion,  and  so  on,  in  reckoning  the  quantity  of  heat 
available,  and  allows  also  for  the  waste  of  mechanical  power  in- 


THEORIES    OF    DIETETICS.  25 

volved  in  the  form  and  structure  of  the  limbs.  To  make  all 
these  allowances  necessitates  courses  of  experiments  and  calcula- 
tions which  have  taken  more  than  a  generation,  and  will  probably 
take  more  than  another  generation  to  complete.  But  the  road 
seems  clear,  and  already  we  have  gained  fruitful  information  as 
to  the  sort  of  food  by  which  we  can  expect  to  get  most  work  out 
of  men  and  beasts;  we  have  found  the  cause  of  many  of  our 
failures  in  distributing  victuals ;  and  we  have  learned  how  to  avoid 
much  cruelty  and  injustice  that  our  fathers  unknowingly  perpe- 
trated. 

It  may  be  reckoned  from  experimental  calculations,  too  long  to 
be  inserted  here,  that  the  expenditure  of  force  in  working  the 
machinery  of  the  body — in  raising  the  diaphragm  about  fifteen 
times,  and  contracting  the  heart  about  sixty  times  a  minute ;  in 
continuously  rolling  the  wave  of  the  intestinal  canal ;  and  in 
various  other  involuntary  and  voluntary  movements  which  can- 
not be  avoided  even  by  a  mere  cumberer  of  the  ground,  without 
doing  anything  that  can  be  called  work — it  may  be  reckoned  that 
the  expenditure  of  force  in  doing  this  is  equal  to  that  which 
would  raise  a  man  of  ten  stone  10,000  feet.  But  a  man  cannot 
even  pick  oakum  without  expending  more  force  and  requiring 
more  to  support  it.  A  prisoner  on  penal  diet  has  half  as  much 
again. 

There  are  several  reasons  for  believing  that  in  assigning  their 
physiological  functions  to  the  several  sorts  of  food,  we  should  as- 
cribe nearly  all  the  business  of  giving  birth  to  force  to  the  solid 
hydrocarbons,  starch  and  fat,  by  their  conversion  into  carbonic 
acid,  just  as  we  have  good  grounds  for  thinking  that  it  is  the  con- 
version of  the  solid  hydrocarbon,  coal,  into  carbonic  acid,  which 
drives  our  locomotives.  It  is  not  necessary  to  be  acquainted  with 
every  step  of  the  process,  which,  in  the  body,  we  confessedly  are 
not,  to  appreciate  the  argument.  To  the  nitrogenous  aliments 
seems  allotted  the  task  of  continuously  replacing  the  wear  and 
tear  of  the  nitrogenous  tissues.  Flesh  food,  or  that  which  comes 
near  it  in  nitrogenous  contents,  after  a  few  changes  replaces  the 
lost  flesh  which  has  passed  away  in  excretions  ;  and  thus  the  en- 
gineer takes  iron  ore,  makes  it  into  wrought  plates  or  steel,  and 
renews  the  corroded  boiler-plate  or  worn  piston-rod.  One  of  the 
most  cogent  of  these  reasons  is  that  the  chief  nitrogen-holding 


26  GENERAL    DIETETICS. 

excretion,  the  urea,  is  little,  if  at  all,  increased  in  quantity  by  an 
increase  in  the  work  done :  whereas  the  excretion  of  carbonic 
acid,  in  a  decided  manner,  follows  the  amount  of  muscular  exer- 
tion. Now  it  is  very  clear  that  if  the  supply  of  power  to  do 
work  depended  on  the  renewal  by  food  of  the  nitrogenous  tissues, 
and  on  their  decomposition,  the  urea  would  have  no  escape  from 
being  largely  augmented  in  quantity  by  muscular  efforts,  and  di- 
minished by  rest.  This  is  not  the  case.  At  first,  exercise  dimin- 
ishes the  amount  of  urea  (Parkes),  and,  even  when  continued, 
very  little  increases  it  (E.  Smith,  Haughton  and  several  others 
quoted  in  Parkes's  "  Hygiene,"  p.  383).  The  very  small  increase 
which  takes  place  during  the  following  rest  may  be  attributed 
fairly  to  the  extra  wear  of  the  muscles  from  extra  motion,  just  as 
a  steam-engine  is  expected  to  require  more  repair  than  usual  when 
in  hard  use.  But  that  amount  of  repair  demanded  is  as  nothing, 
compared  with  the  increase  in  the  tonnage  of  coal  consumed. 

To  give  an  example  of  the  mode  of  working  out  a  problem  by 
this  theory  :  Dr.  Frankland  ascertains  with  the  calorimeter,  which 
calculates  the  amount  of  heat  evolved  as  a  thermometer  does  its 
degree,  the  quantity  of  energy  or  force,  under  the  form  of  heat, 
evolved  during  the  complete  oxidation  in  the  laboratory  of  a  given 
weight  of  alimentary  substance.  It  was  explained  before,  that 
heat  and  mechanical  work,  being  convertible  into  one  another, 
bear  an  eternally  sure  proportion  to  one  another :  now,  and  forever, 
a  definite  production  of  so  much  heat  represents  the  potentiality  of 
so  much  motion,  used  or  wasted,  according  to  circumstances.  So 
that  from  the  reading  of  the  calorimeter  may  be  reckoned  how 
many  extra  pounds  ought  to  be  raised  a  foot  high  by  a  man  who 
has  eaten  an  extra  pound  of  the  food  in  question  ;  how  many  steps 
a  foot  high  he  ought  to  raise  himself  (say  a  weight  of  ten  stone) 
before  he  has  worked  out  the  value  of  his  victuals.  Dr.  Frank- 
land  has  thus  estimated  the  comparative  value  of  foods  as  bases  of 
muscular  exertion,  and  he  has  made  out  a  table  of  the  weight  and 
cost  of  various  articles  that  would  require  to  be  consumed  in  the 
system  to  enable  a  man  of  ten  stone  to  raise  himself  10,000  feet. 
This  is  equal  to  going  up  a  ladder  two  miles  and  one-third  high — 
a  stiff"  day's  work.  Three  pounds  and  a  half  of  lean  beef  at  a  cost 
of  at  least  3s.  Qd.  would  be  wanted;  but  if  little  more  than  half  a 
pound  of  suet,  worth  about  5|<i,  were  substituted,  the  same  effect 


THEORIES    OF    DIETETICS.  27 

might  be  elicited.  A  liberal  three  quarts  of  milk  at  5d.  a  quart 
would  do  the  same  thing ;  but  if  cabbages  or  apples  happened  to 
be  the  only  available  food,  12  Ibs.  of  the  former  or  nearly  8  Ibs. 
of  the  latter  must  be  swallowed — an  intolerable  burden  even  for 
the  dura  messorum  ilia.  There  is  great  wisdom,  then,  in  the  jour- 
neyman tailor  who  adds  suet  or  bacon  to  his  cabbage,  and  in  the 
Yorkshireman  who  puts  a  slice  of  cheese  in  the  apple-pie  which 
often  serves  him  for  breakfast,  dinner,  and  supper — for  the  said 
cheese  is  very  high  in  the  scale  of  nutrimentary  fuel,  and  IQd. 
will  buy  as  much  of  it  as  is  equal  to  the  3|  Ibs.  of  beef.  But  in 
wheaten  bread  we  find  a  true  friend,  for  of  it  two  pounds  and  a 
third,  costing  under  5d.,  supply  a  food  which  really  might  be 
eaten  alone;  whereas  the  consumption  of  the  others  as  a  sole  diet 
is  of  course  theoretical — the  average  digestive  organs  cannot  bear 
them.  The  mere  weight,  for  instance,  of  12  Ibs.  of  cabbage  would 
knock  a  man  up,  if  carried  in  a  vessel  so  ill  adapted  to  sustain 
heavy  loads  as  the  stomach. 

Reverting  now  to  the  gang  of  a  hundred  prisoners  formerly 
used  as  an  illustration,  and  supposing  we  wanted  to  put  them  on 
hard  labor  involving  some  exertion  equivalent  to  half  Dr.  Frank- 
land's  unit  of  ten  stone  raised  10,000  feet — such,  for  instance,  as 
carrying  1^  mile,  up  ladders,  three  tons  of  stone  daily — we  should 
find  by  calculation  that  the  addition  of  117  Ibs.  of  bread,  or  of  58 
Ibs.  of  bread  with  44  Ibs.  of  lean  meat  and  63  Ibs.  of  potatoes,  to 
that  diet  which  would  keep  up  their  flesh,  without  labor,  would 
be  barely  sufficient,  and  that  they  would  lose  a  little  weight  daily. 
Cases  of  illness  from  overwork  would  be  improperly  frequent. 
Give  them  a  draught  of  milk,  or  a  cup  of  cocoa  and  sugar,  or 
some  oatmeal-porridge  and  treacle,  or  even  some  green  vegetables, 
and  the  danger  is  probably  averted.  But  yet,  a  wide  margin 
must  be  allowed  for  discretionary  modification  according  to  cir- 
cumstances which  the  immediate  administrators  of  victualling 
arrangements  alone  can  observe. 

Still  more  necessary  is  modification  according  to  circumstances 
required,  when  we  come  to  deal  with  individuals  instead  of  masses. 
When  the  tailor  in  Laputa  sternly  refused  to  take  the  usual  meas- 
urements, and  insisted  on  constructing  Captain  Gulliver's  coat, 
waistcoat,  and  breeches  on  abstract  principles,  the  customer  vowed 
it  was  the  worst  suit  of  clothes  he  ever  had  in  his  life.  We 


28  GENERAL    DIETETICS. 

should  certainly  fail  in  the  same  way  if  we  did  not  take  the  meas- 
ure of  numberless  contingencies  in  the  daily  life,  and  numberless 
peculiarities  in  the  persons  of  those  who  consult  us  about  their 
diet  and  regimen,  or  who  are  (like  the  inmates  of  prisons)  actually 
dependent  upon  us  for  living  at  all. 

Even  healthy  persons  are  not  absolutely  perfect  in  the  perform- 
ance of  all  their  functions,  and  a  good  deal  of  the  food  swallowed 
escapes  digestion  and  is  wasted  among  the  excreta.  A  considera- 
ble margin  must  be  allowed  for  that.  And  different  forms  of 
food  and  different  preparations  of  those  forms  are  suited,  from 
their  mere  mechanical  construction,  to  different  constitutions  of 
body.  A  diet  which  in  an  old  man  may  be  wasted  from  lack  of 
solution,  and  which  would  therefore  be  a  starvation  diet  to  him, 
may  in  a  young  man  be  richly  ample.  On  the  other  hand,  the 
easily  soluble,  but  scanty  diet  on  which  the  old  man  might 
flourish,  would  not  suffice  for  his  active,  growing  grandson. 
Then  again,  very  different  lives  are  necessarily  led  by  different 
men,  and  even  by  the  same  man  at  various  times,  and  variations 
in  the  mere  quantity  of  food,  at  the  instigation  of  appetite,  are  not 
sufficient  to  accommodate  the  diet  to  the  work.  Brain-work, 
body-work,  indoor  work,  and  outdoor  work,  all  introduce  modi- 
fications in  the  daily  requirements  of  the  nutritive  organs.  There 
are  also  physiological  drains  upon  the  constitution,  such  as  that 
felt  by  a  nursing  mother,  and  pathological  drains,  such  as  that  of 
a  purulent  discharge,  which  have  to  be  provided  for.  And  it 
must  be  remembered  also  that  many  morbid  conditions,  which 
yet  do  not  keep  a  patient  from  his  employment,  such  as  gastric 
catarrh  or  tuberculosis,  yet  interfere  with  the  due  solution  of  the 
meals.  And  some,  such  as  gout  and  diabetes,  are  aggravated  by 
eatables  which  are  wholesome  to  a  healthy  constitution.  And 
there  are  hereditary  tendencies  which  may  be  turned  into  diseases 
by  popular  articles  of  diet,  and  not  a  few  idiosyncrasies  to  be 
allowed  for. 

With  the  safeguards  of  due  allowance  for  the  above  elements  of 
variation,  and  a  close  eye  upon  current  experiment,  the  theory  of 
demand  and  supply  in  dietetics  may  be  turned  to  the  very  best 
account  by  rational  medicine. 


ON    THE    CHOICE    OF    FOOD.  29 


CHAPTER  II. 

ON  THE   CHOICE  OF   FOOD. 

THERE  is  no  rule  capable  of  such  universal  application  as  that 
all  articles  designed  for  human  food  should  be  the  best  of  their 
kind  which  can  be  procured,  and  that  it  is  false  economy  to  be 
tempted  by  a  lower  price  to  be  satisfied  with  less  eligible  wares. 
The  saving  in  money  is  always  outbalanced  by  the  inferior 
utility.  Economy,  when  necessary,  should  be  practiced  in  quan- 
tity, not  quality,  in  the  sort  of  food  chosen,  and  not  in  its  degree 
of  perfection. 

As  to  the  arrangement  of  the  subject,  the  naturalist's  classifica- 
tion has  been  that  usually  adopted  by  authors.  But  it  seems  to 
me  less  scientifically  appropriate  to  the  matter  in  hand,  and  more 
likely  to  involve  repetition,  than  one  which  brings  together  arti- 
cles associated  in  the  market,  and  which,  indeed,  often  combine 
elements  derived  from  several  realms  of  nature.  These  articles 
are  here  to  be  considered  solely  as  food  for  man,  and  not  as  inde- 
pendent members  in  creation. 

§  1.  BUTCHER'S  MEAT. 

The  lean  of  butcher's  meat  should  show  a  deep  purplish  red 
tint,  with  a  sort  of  bloom  over  it,  on  the  outside  of  the  muscle  and 
a  lighter  vermilion  red  with  a  bare  shade  of  purple  in  the  cut 
surface.  The  lean  of  beef  may  be  a  little  marbled  with  fat,  but 
that  of  mutton  should  be  quite  even  in  hue.  When  cut  in  a  very 
fine  slice,  or  stretched  in  a  thin  layer  over  the  fat,  as  naturally 
in  the  ribs,  it  is  semi-transparent  and  orange-vermilion  in  uniform 
streaks.1 

The  surface  is  quite  dry,  and  even  the  cut  should  scarce  wet  the 
finger.  In  substance  it  is  moderately  soft,  but  extremely  elastic, 

1  The  "  vermilion  "  and  "  purple  lake  "  of  the  paint-box  are  the  only  colors 
required  to  copy  the  lights  and  shades  of  healthy  meat. 


30  GENERAL    DIETETICS. 

so  that  no  mark  is  left  after  pressure.  A  day  or  two  in  the  larder 
should  make  no  difference  in  this  respect. 

There  is  very  little  odor  in  a  single  joint  of  good  meat,  and 
what  there  is,  to  most  people,  is  not  unpleasant.  When  made 
powerful  by  accumulation,  as  in  a  shop,  it  may  be  described  as  re- 
freshing and  exhilarating,  like  a  sea  breeze. 

It  should  not  waste  much  in  cooking.  That  is  to  say,  it  should 
not  contain  an  excess  of  water,  nor  part  with  it  too  easily.  Dried 
in  the  laboratory,  healthy  muscular  fibre,  according  to  Dr. 
Letheby,1  does  not  part  with  above  70  to  74  per  cent,  of  its 
weight;  whereas,  when  in  an  unhealthy  condition,  it  will  lose  as 
much  as  80  per  cent.  Cooking  is,  of  course,  not  the  complete 
chemical  desiccation  alluded  to;  but  its  relation  to  animal  fibre  is 
the  same. 

When  a  joint  is  brought  to  table  roasted,  it  holds  well  its  gravy, 
which  gushes  out  when  a  cut  is  made,  in  a  rich  brown  stream,  full 
of  appetizing  scent  and  flavor,  and  called  graphically  by  the 
chemist "  Osmazome." 

The  tastes  of  the  tissues  should  be  quite  distinct  from  one 
another.  The  mutton  lean  should  have  no  flavor  of  tallow,  nor 
the  beef  of  suet.  Tenderness,  of  course,  is  a  virtue,  but  freshness 
should  not  be  sacrificed  to  it. 

The  raw  fat  of  beef,  whose  base  is  principally  margarin,  should 
be  of  a  light  yellow  color,  like  fresh  butter;  that  of  mutton,  which 
is  mainly  stearin,  should  be  very  white. 

Lamb  and  veal  should  have  very  white  and  translucent  fat ; 
and  if  the  whole  carcase  can  be  examined,  the  fat  about  the  kid- 
neys should  be  especially  observed,  as  that  is  not  rarely  reddish 
and  unwholesome,  while  the  rest  is  in  good  condition. 

Of  these  two  latter  meats,  the  lean  should  be  pale,  but  even  in 
tint  and  free  from  mottling. 

The  above-mentioned  features  of  prime  meat  are  still  more  to 
be  insisted  upon  when  we  choose  the  various  internal  parts.  They 
decompose  quicker,  and  when  decomposed  are  more  unwholesome, 
than  ordinary  muscular  fibre.  They  should  have  a  clean  bright 
even  color  throughout,  and  be  free  from  spots,  speckles,  and  points 
of  congestion  or  of  bruises. 

1  Lectures  on  Food,  p.  235_ 


ON    THE    CHOICE    OF    FOOD.  31 

Liver,  kidneys,  and  heart  become  very  hard  by  too  great  or  too 
prolonged  heat.  Unless,  therefore,  a  very  small  dish  is  required, 
they  should  be  avoided. 

Butchers  are  fond  of  palming  off  the  pancreas,  or  "stomach- 
bread,"  in  place  of  the  "sweet-bread,"  which  is  the  thymus  gland 
of  the  calf.  It  may  be  recognized,  even  when  cooked  and  chopped 
up,  by  its  large  veins  and  arteries.  It  is  very  inferior  in  digesti- 
bility to  the  more  delicate  gland. 

In  roasting,  the  fat  of  meat  should  not  run  away  intQ  the  drip- 
ping. 

If  these  characteristics  are  insisted  upon,  we  may  be  satisfied 
that  our  kitchen  is  provided  with  the  best  article,  however  moder- 
ate the  price  may  be;  without  them  we  are  ill  served,  however 
much  we  pay.  They  are  guarantees  of  wholesomeness,  and  there- 
fore worth  more  than  all  the  negative  evidence  of  absence  of  un- 
wholesomeness. 

The  immediate  antecedents,  and  the  mode  of  slaughtering  the 
animal  certainly  very  much  affect  the  nature  of  its  flesh.  Chronic 
loss  of  health  of  any  kind  makes  it  not  only  less  easy  of  digestion, 
but  less  nutritious  in  proportion  to  the  quantity  eaten.  The  mus- 
cular fibre  of  a  beast  in  poor  condition  is  pale  in  color,  pinkish, 
yellowish,  or  brownish.  A  quantity  of  watery  fat,  of  a  bad  color, 
is  intimately  mixed  up  with  the  fasciculi.  The  colors  of  the  two 
seem  to  blend  so  as  to  present  a  marbled  aspect.  Such  meat  is 
wet,  sodden  and  inelastic.  If  it  retains  the  mark  of  a  finger 
pressed  upon  it,  it  is  unfit  to  eat.  When  left  unwiped,  it  parts 
with  its  watery  constituents,  and  soon  lies  in  a  pool  of  blood- 
stained fluid.  When  cooked  its  gravy  is  pale  and  mawkish,  and 
it  has  lost  a  good  deal  of  its  substance.  In  the  museum  of  the 
College  of  Surgeons1  there  is  preserved  a  mutton-chop,  the  meat 
of  which  is  converted  into' a  waxy  or  adipocerous  substance,  obvi- 
ously no  more  fit  for  food  than  are  those  sticks  of  adhesive  matter 
with  which  our  beaux  stiffen  their  whiskers.  This  is  simply  an 
extremely  advanced  specimen  of  a  condition  which  is  commenc- 
ing interstitially  in  the  carcases  of  all  chronically  invalided  animals. 
It  is  that  degeneration  of  muscle  with  which  the  classical  descrip- 
tion of  Dr.  Quain  made  all  in  our  profession  familiar  twenty-five 

1  No.  10  in  the  Catalogue  of  the  Pathological  Series.. 


32  GENERAL    DIETETICS. 

years  ago,1  as  occurring  in  the  human  body.  It  is  found  not  only 
in  organs  which  have  been  exhausted  by  chronic  inflammations, 
but  in  those  which  are  simply  hypertrophied,  and  with  a  fre- 
quency closely  proportioned  to  the  frequency  with  which  the  special 
organs  become  so  enlarged. 

It  is  the  more  important  to  notice  the  effect  of  chronic  disease 
upon  the  flesh  of  adult  animals,  because  it  does  not  in  many  cases 
prevent  their  being  fatted  up  for  market  and  presenting  a  delusive 
appearance  of  prime  condition.  Thus  the  "  rot,"  always  associ- 
ated with  the  presence  of  fluke-worms  in  the  liver,  exhibits  itself 
at  an  early  stage  in  the  sheep  by  a  great  tendency  to  plumpness. 
The  shrewd  breeder,  Mr.  Bakewell,  "to  whom  farmers  owe  so 
much  "  (more  indeed  than  their  customers),  "  used  to  overflow  cer- 
tain of  his  pastures,  and  when  the  water  was  run  off,  turn  upon 
them  those  of  his  sheep  which  he  wanted  to  prepare  for  the  mar- 
ket. They  speedily  became  rotted,  and  in  the  early  stage  of  the 
disease  they  accumulated  flesh  and  fat  with  wonderful  rapidity. 
By  this  manoeuvre  he  used  to  gain  five  or  six  weeks  upon  his 
neighbors."2  But  what  was  the  worth  of  this  hypertrophied 
muscle  and  adipose  tissue?  Breeders,  if  they  give  a  thought  to 
the  subject,  must  be  conscious  that  the  heart  and  arteries  do  not 
grow  at  the  same  morbid  pace  with  the  rest  of  the  body,  and  the 
animal,  imperfectly  supplied  with  blood,  is  in  a  state  of  extreme 
anaemia.  Indeed,  one  of  the  earliest  known  and  best  known  tests 
of  "  rot,"  is  the  condition  of  the  eyeball  and  lid,  the  inside  of 
which  is  injected,  but  pale  and  tallowy,  while  the  tear-gland  is 
yellow  instead  of  pink.3  We  know  the  look  well  in  our  chlorotic 
patients. 

Not  quite  so  pronounced,  but  of  the  same  nature,  is  the  anaemia 
which  results  from  the  constant  efforts  of  the  farmer  to  produce  a 
flock  which  will  lay  on  the  greatest  weight  of  flesh  in  the  shortest 
possible  number  of  weeks.  Premature  development  of  size  and 

1  See  the  plates  in  the  Medico-chirurgical  Transactions,  vol.  xxxiii,  p.  196. 
The  coloring  is  very  accurate. 

2  Youatt,  The  Sheep,  p.  446. 

3  "  That  dire  distemper  sometimes  may  the  swain 
Though  late  discern  ;  when  on  the  lifted  lid 
Or  visual  orb,  the  turgid  veins  are  pale." 

Dyer's  Fleece,  book  i,  line  266. 


ON    THE    CHOICE    OF    FOOD.  33 

of  puberty  is  in  his  sight  a  virtue,  both  in  those  destined  for  the 
butcher  and  in  those  he  selects  as  breeders.  It  is  a  saving  of  time, 
and  time  is  money.  I  fear  our  agricultural  societies  are  not  free 
from  the  blame  of  this,  inducing  competition  in  bulk  by  their  sys- 
tem of  prizes  ;  and  I  do  not  see  how  they  can  counteract  the  evil 
that  has  been  wrought,  unless  by  instituting  rewards  for  prime 
joints,  to  be  adjudged  at  the  table  as  well  as  in  the  larder. 

Good  mutton  is  generally  small;  indeed  large  mutton  can  only 
be  good — these  hypertrophied  breeds  can  only  l>e  thoroughly 
prime — by  being  kept  alive  till  their  constitution  has  grown  up 
to  their  size.  To  illustrate  the  matter  by  our  own  race,  a  school- 
boy of  six  foot  one  never  becomes  hearty  till  he  is  at  least  one  or 
two  and  twenty.  But  after  that,  the  weedy  youth  may  harden 
and  be  a  fine  man.  So  indeed  with  these  overgrown  lambs,  if 
they  are  kept  till  four  years  old,  the  meat  is  very  choice ;  but  of 
course  the  temptation  is  to  bring  them  to  the  butcher  directly  they 
are  as  tall  and  broad  as  a  real  sheep ;  and  the  farmer  looks  upon 
himself  as  a  benefactor  to  his  species,  as  having  made  two  animals 
in  the  time  formerly  required  to  make  one.  But  I  hear  with 
sorrow  of  attempts  being  made  to  "  improve,"  as  it  is  called,  the 
Welsh  breed,  and  trust  they  may  be  unsuccessful.  A  more  promis- 
ing statement  is  that  Welsh  mutton,  in  the  London  market,  is 
imitated  by  a  cross  between  the  Southdown  and  the  Scotch.1  We 
may  pardon  the  deception,  if  the  meat  is  as  good  as  its  model. 

A  striking  proof  of  how  opposed  .are  the  interests  of  the  farmer 
and  of  the  consumer  in  the  breeding  of  sheep  is,  that  in  the  minute 
experiments  and  calculations  of  the  advantage  of  different  breeds 
and  various  modes  of  feeding,  no  attempt  is  made  to  reckon  the 
goodness  of  the  dead  meat.  We  are  told  the  weight,  but  never 
the  quantity  of  osrnazome  it  contains,  though  the  readiest  possible 
test  in  the  tint  of  the  gravy  is  very  familiar  to  the  eater. 

To  get  good  mutton  in  country  places  is  now  a  serious  problem, 
and  I  would  suggest  to  my  professional  brethren,  who  are  of 
course  permanent  residents,  that  they  cannot  confer  a  greater  boon 
on  families  in  the  same  position  of  life  as  most  of  us  are,  that  is  to 
say,  not  rich  enough  to  have  parks  and  farms,  and  yet  willing  to 
pay  a  good  price  for  a  good  article — I  say  they  cannot  confer  a 


1  Macdonald,  Cattle,  Sheep,  and  Deer,  p.  483. 


34  GENEKAL    DIETETICS. 

greater  benefit  on  these  their  neighbors,  than  by  inducing  them  to 
join  in  a  "  mutton  club,"  buying  the  lambs  of  a  full-sized  breed, 
and  keeping  them  to  at  least  three  and  a  half  years  old  before 
killing.  The  price  per  pound  will  not  be  less  than  charged  by 
the  butcher,  but  it  will  supply  an  article  twice  as  good  as  his. 

There  has  been  felt  a  good  deal  of  alarm,  more  I  think  than  is 
justifiable,  during  the  last  few  years  on  the  subject  of  the  class  of 
parasites  which  are  not  uncommon  in  the  flesh  of  all  animals, 
namely,  the  cysticwcus  and  the  trichina  ;  and  which,  when  suffi- 
ciently numerous  to  be  conspicuous,  constitute  what  is  called 
"  measly  meat." 

The  cysticercus  of  the  pig  is  the  sort  most  frequently  seen,  form- 
ing a  cyst  as  large  as  a  hemp-seed.  Its  commonest  habitat  is  the 
tongue,  on  the  under  surface  of  which  it  may  be  discovered  even 
without  cutting  into  the  interior.  You  may  also  find  the  oval 
holes  left  by  it  when  dried  up  in  otherwise  very  perfect  hams, 
and  opaque  white  specks,  like  seeds,  intimately  adherent  to  the 
muscular  fibres,  which  are  its  remains  dried  into  calcareous  mat- 
ter. This  measle-worm  of  the  pig  has  been  found  by  the  indus- 
trious German  naturalist  Kiichenmeister  to  be  the  undeveloped 
embryo  of  the  Tcenia  sotium,  the  tape-worm  of  most  usual  occur- 
rence in  Great  Britain.  By  keeping  them  alive  in  warm  milk  he 
was  able  to  watch  the  development  of  the  animals.  The  cysticer- 
cus of  the  ox  is  smaller,  and  is  either  rarer  or  seldoraer  discovered 
in  this  country.  It  becomes  the  Tcenia  mediocanellata,  the  species 
which  infests  the  intestines  of  Germans,  Swiss,  and  others,  pro- 
ducing exactly  the  same  inconveniences  as  that  with  which  we  are 
familiar.  As  the  measle-worm  of  the  mouse  produces  the  peculiar 
tape-worm  of  the  cat  (Tcenia  crassicollis),  as  the  brain  hydatid  of 
the  sheep  (Qxnurus  cerebralis)  produces  the  Tcenia  ccenurus  in  the 
dog,  so  the  minute  larva  which  infests  the  flesh  of  our  prey  re- 
venges itself  on  its  natural  enemy.  An  old  boa-constrictor  is 
always  a  complete  museum  of  tape-worms,  derived  from  the  various 
living  game  which  it  has  devoured. 

Now,  there  is  no  doubt  that  the  boiling  temperature  entirely 
destroys  the  vitality  of  these  creatures.  When  cooked  they  can 
do  us  no  more  harm  than  a  baked  lion.  So  that  it  can  very  rarely, 
if  ever,  happen  in  civilized  countries  for  them  to  be  transmitted 
directly  to  human  intestines.  Another  mode  of  communication 


ON    THE    CHOICE    OP    FOOD.  35 

must  be  thought  of,  and  I  think  it  is  not  far  to  seek.  Though  we 
do  not  eat  our  food  raw,  dogs  very  often  do,  and  they  distribute 
far  and  wide  by  their  excreta  all  that  escapes  the  solution  of  the 
gastric  juice.  Thus  the  embryos  get  spread  abroad  on  the  earth, 
into  streams  and  wells,  and  especially  in  our  kitchen  gardens 
among  the  materials  of  our  solids.  I  had  once  brought  to  me  a 
child  three  years  old,  with  tape-worm,  a  very  rare  thing  at  that 
age,  and  thus  affording  peculiar  facilities  for  detecting  its  origin. 
It  was  the  son  of  a  sculptor  in  the  suburbs  of  London,  and  all  the 
cooking  arrangements  of  the  family  seemed  perfect,  as  also  their 
water  supply.  But  in  the  stone-yard,  which  had  once  been  a  gar- 
den, grew  a  quantity  of  nasturtiums,  and  among  these  the  baby 
used  to  play,  and  sometimes  ate  the  flowers  and  fruit.  As  the 
yard  was  open  to  the  road,  it  was  much  frequented  by  the  dogs  of 
the  neighborhood,  and  showed  unmistakable  signs  of  their  pres- 
ence. One  could  not  question  that  here  lay  the  carrier  of  the  little 
patient's  troublesome  inmate.  The  observant  and  enthusiastic 
physician  of  Iceland,  Dr.  Hjalteliu,  also  informs  me  that  intestinal 
parasites  are  exceedingly  common  in  that  country,  and  that  the 
cause  appears  to  be  the  distribution  of  their  ova  by  stray  dogs  who 
are  always  in  and  out  of  the  kail  gardens.  Another  possible 
source  of  tcenia  may  be  shell-fish,  eaten  raw,  and  often  containing 
in  their  stomachs  minute  organisms  derived  from  decayed  garbage 
thrown  away  or  used  as  bait.  Only  the  other  day  I  found  in  the 
prehensile  organs  of  a  prawn  a  shred  of  animal  fibre,  and  saw  a 
man  fishing  for  crabs  and  prawns  at  the  mouth  of  the  Arun  with 
a  piece  of  paunch.  With  all  these  possible  sources  of  infection 
there  is  no  need  to  suspect  butcher's  meat,  which  is  never  eaten 
raw  except  by  some  eccentric  amateur  savage. 

The  real  evil  of  measly  meat  consists  in  its  proueness  to  rapid 
decomposition  in  spite  of  cookery,  and  to  that  may  fairly  be 
credited  cases  of  illness  which  are  reputed  to  have  followed  itH 
consumption.  So  that  it  is  fair  enough  that  all  that  is  largely 
infected  should  be  destroyed.  In  France  there  used  to  be  ap- 
pointed to  the  markets  officers  called  "  langueyeurs"  from  their 
inspecting  the  tongues  of  carcasses  offered  for  sale;  but  their  legal 
authorization,  and  possible  tyranny,  seems  to  have  given  dissatis- 
faction, for  M.  Delpech  says  they  have  no  lawful  authority,  but 
are  employed  simply  as  a  warrant  between  buyer  and  seller. 


36  GENERAL    DIETETICS. 

They  have  to  report  to  the  inspector  of  markets,  usually  a  skilled 
veterinarian,  who  judges  if  the  quantity  of  measle-worm  is  suffi- 
cient to  render  the  meat  unwholesome.  The  shoulder  and  the 
breast  are  the  parts  usually  examined  as  tests.1 

The  Trichina  spiralis  is  another  parasitic  inhabitant  of  live  flesh, 
of  a  more  active  character  and  of  a  higher  grade  in  creation  than 
that  last  discussed ;  for  instead  of  being  a  solid  worm  like  the 
ta^nia,  it  is  possessed  of  an  intestine.2  It  is  sometimes  found  in 
human  flesh  and  in  pork,  appearing  as  a  minute  white  speck,  just 
visible  to  the  naked  eye,  which  constitutes  its  nest,  in  which  one 
or  two  curled-up  specimens  are  seen,  by  a  microscope,  in  active 
movement,  but  prevented  from  doing  harm  by  the  cyst  in  which 
they  are  imprisoned.  The  danger  consists  in  its  escape  and  won- 
derfully rapid  multiplication,  under  special  circumstances  not 
very  clearly  defined ;  for  it  exists  at  most  times  in  considerable 
numbers  without  giving  rise  to  any  symptoms  whatever.  But 
there  seems  sufficient  evidence  that  in  a  few  instances  an  epidemic 
has  occurred  of  its  invasion,  in  overpowering  quantities  at  once, 
of  human  bodies,  through  the  food  eaten.  The  symptoms  are  in- 
flammatory fever  and  local  lesions  from  the  interstitial  presence  of 
a  mass  of  quickly  increasing  foreign  bodies.  But  these  instances 
have  been  extremely  rare.  A  few  years  ago  a  physiologist  in  this 
metropolis,  having  become  the  fortunate  possessor  of  some  speci- 
mens of  live  trichina,  instantly  invited  a  crowded  conversazione  of 
medical  men  and  others  interested  in  the  natural  history  of  our 
species,  and  introduced  to  them  by  means  of  the  hydro-oxygen 
microscope  his  acquisition.  Very  few  of  the  party,  if  any,  had 
seen  one  before ;  and  very  few,  if  any,  have  seen  one  since. 

The  trichina  is  said  to  cause  degeneration  of  the  muscular  fibres 
in  its  vicinity,  so  that  the  joints  infested  would  not  present  the 
healthy  appearance  described  at  the  beginning  of  this  section.  It 
is  killed  by  the  temperature  of  boiling  water,  PO  that  if  a  dish  is 
fairly  cooked,  it  must  be  quite  safe.  The  cases  which  have  oc- 
curred of  its  proving  deleterious  have  been  where  the  meat  has 
been  eaten  raw,  or  imperfectly  warmed  through  and  served  cold, 

1  Delpech,   Diet,  encycl.  des  sciences  med.,  art.  "  Ladrerie :  "  an  excellent 
monograph  on  the  subject,  date  18C8. 

2  Professor  Owen  has  identified  the  trichina  as  one  of  the  Coelelminlha,  and 
the  College  of  Physicians  has  adopted  his  classification. 


ON    THE    CHOICE    OF    FOOD.  37 

•with  its  defects  concealed  by  some  enveloping  sauce.  No  decently 
delicate  feeders  need  be  afraid  of  it.  If  the  leaden  dull  color  of 
the  meat  before  us  has  been  destroyed,  so  that  it  does  not  look  raw 
when  the  gravy  is  run  off,  and  if  the  peculiar  texture  of  fibre 
which  distinguishes  uncooked  meat,  is  removed,  we  may  be  sure 
that  the  temperature  has  mounted  up  to  that  sufficient  to  coagu- 
late albumen  (150°  Fahr.),  and  that  any  stray  trichina  would  be 
killed  on  the  spot  or  permanently  imprisoned  in  a  solid  nest. 

It  may  be  proper  to  mention  that  no  form  of  drying,  salting, 
or  even  smoking  at  a  low  hea't,  is  sufficient  to  destroy  the  trichina. 
So  that  when  travelling  in  Germany  it  is  wise  altogether  to  avoid 
the  sausages  and  uncooked  ham  often  served  up  in  thin  slices,  and 
which  in  point  of  fact,  have  been  proved  the  sources  of  trichinous 
poisoning  in  the  few  instances  on  record. 

The  whole  influence  of  fevers  and  inflammations  upon  the  flesh 
of  animals  thereby  affected  during  life,  and  whether  they  should 
be  considered  as  a  reason  for  its  being  pronounced  absolutely  unfit 
for  food,  is  a  moot-point.  There  is  a  good  deal  of  hearsay  evi- 
dence on  both  sides,  but  I  cannot  find  any  crucial  cases  recorded 
as  observed  by  competent  witnesses.1  An  enormous  quantity  of 
meat  is  destroyed  on  this  ground,  for,  according  to  Mr.  Youatt's 
estimate,  one-fifteenth  of  the  whole  horned  stock  of  the  country 
die  annually  of  inflammatory  fever,  milk  fever,  red-water,  hoove, 
and  diarrhoea,  and  one-tenth  of  the  sheep  and  lambs  are  carried 
off  by  corresponding  ailments.2  When  we  add  those  which  perish 
by  accident  and  accidental  sickness,  it  is  obvious  that  several  mil- 
lion tons  of  meat  are  thus  taken  out  of  human  mouths  by  the  law 
which  insists  on  the  destruction  of  all  which  bears  the  marks  of 
disease.  Opponents  say  that  if  it  possess  only  a  fraction  of  the 
nutritive  power  of  good  meat,  it  ought  not  to  be  wasted,  but  sold 
at  a  lower  price,  provided  always  proof  can  be  obtained,  that  it 
does  not,  when  eaten,  communicate  disease.  This,  as  said  before, 

1  "In  no  well-ascertained  case  has  it  been  found  that  any  ill  eftects  have  been 
produced  by  eating  the  flesh  of  diseased  animals,  although  there  is  abundant 
evidence  that  at  the  outbreak  of  the  distemper  in  Massachusetts,  and  before 
public  attention  had  been  directed  to  its  true  character,  a  considerable  num- 
ber of  animals,  in  which  the  usual  premonitory  symptoms  had  appeared,  were 
slaughtered  and  their  flesh  sold." — Second  Annual  Report  of  the  State  Board 
of  Health,  Massachusetts,  1871. 

2  Youatt,  Cattle,  Preface. 


38  GENERAL    DIETETICS. 

is  a  moot-point,  but  yet  what  is  certain  is  to  my  mind  quite  suf- 
ficient to  justify  the  exclusiveness  of  the  existing  regulations.  It 
is  certain  that  there  are  some  diseases,  originating  in  beasts,  which 
may  be  communicated  to  men  handling  the  carcass  before  it  has 
been  submitted  to  the  action  of  heat,  as  for  example  pustula  ma- 
ligna  and  glanders.  And  some  fevers,  such  as  typhus,  are  com- 
mon to  man  and  beast,  and  are  indubitably  contagious  during 
life,  and  probably  after  death,  till  the  flesh  has  passed  through  the 
purification  of  fire.  Now  most  of  those  who  would  buy  diseased 
meat  on  account  of  its  cheapness,  cook  their  own  victuals,  and  are 
exposed  to  all  the  evils  which  may  accrue  from  handling  a  dan- 
gerous article.  Again,  this  "braxy"  meat,  as  it  is  technically 
called,  runs  rapidly  into  decomposition,  and  becomes  a  serious 
nuisance  on  that  ground  alone.  It  is  also  frequently  saturated 
with  the  soluble  drugs  which  have  been  given  as  medicines  by  the 
veterinarian.  Ergot  of  rye,  digitalis,  opium,  tartar  emetic,  are 
often  administered  in  enormous  quantities.  Mr.  Youatt  advises 
upwards  of  half  an  ounce  daily  of  solid  opium  for  an  ox  with 
lock-jaw,  which  is  240  times  the  full  human  dose,  and  as  this  is 
equally  distributed  to  the  soft  parts  by  the  circulation,  in  a  beast 
(say)  of  twenty  stone,  each  pound  would  contain  at  least  half  a 
grain  of  the  poison.  A  case  is  recorded,  in  which  tartar  emetic 
taken  by  an  ox  before  slaughtering  produced  serious  effects  on  107 
persons  who  partook  of  the  meat.1  One'  person  who  died  had 
eaten  only  half  a  pound.  Tartar  emetic  was  found  in  the  con- 
tents of  his  abdomen. 

Acute  fevers  cause  an  acute  degeneration  or  interstitial  death- 
in-life  of  both  blood  and  tissues.  Virgil  notices  that  in  victims 
slaughtered  during  the  cattle  plague  the  peristaltic  vermicular 
j notions  of  the  intestines,  by  which  the  priests  told  fortunes,  are 
stayed,  and  that  the  blood  is  as  the  blood  of  a  corpse,  scarcely 
staining  the  knife — 

Nee  responsa  potest  consultus  reddere  vates, 

Ac  vix  suppositi  tinguntur  sanguine  cultri. — Georg.  iii,  491. 

And  it  may  be  remarked  that  the  poet,  who  is  a  practical  far- 
mer as  well  as  the  most  picturesque  of  sweet  singers,  expressly 

1  Quoted  by  Dr.  Pavy  from  the  Central  Zeitung  fur  Veterinarmedizin  fur 
1854.  Treatise  on  Food,  etc.,  p.  149. 


ON    THE    CHOICE    OF    FOOD.  39 

says  that  he  is  here  speaking  of  the  early  stage  of  murrain,  the 
fatal  later  symptoms  of  which  he  describes  afterwards.  The  Re- 
ports of  the  Cattle-plague  Committee  of  Privy  Council  show,  that 
his  lines  will  apply  to  England  as  well  as  to  Italy.  Now,  it  can 
hardly  be  maintained  that  it  is  honest  to  sell  in  the  market  meat 
thus  saturated  with  natural  death,  though  the  animal  has  been 
slaughtered  before  the  full  declaration  of  the  fever. 

The  best  possible  meat  may  be  rendered  unwholesome  by  nor- 
mal decomposition.  The  stomach  can,  indeed,  through  habit,  be- 
come used  to  food  in  this  state ;  and  thus  may  be  accounted  for 
the  instances  we  read  in  books  of  travels,  of  savages,  like  the  Es- 
quimaux, who  bury  their  flesh  till  it  is  putrid,  or  like  the  Zulus 
with  whom  (according  to  Dr.  Colenso)  the  synonym  for  heaven  is 
"  maggoty  meat."  Of  course,  rather  than  die  of  starvation,  or  be 
reduced  to  the  straits  suffered  by  Hezekiah's  army,  one  would 
acquire  such  a  habit,  and  invent  a  sauce  to  make  it  tolerable ;  but 
it  is  scarcely  worth  while  to  do  so  in  civilized  society.  Under 
ordinary  circumstances  many  cases  are  recorded  in  works  upon 
poisons,  such  as  Dr.  Christison's,  where  decayed  animal  food  has 
produced  severe  and  even  fatal  diarrhoea,  in  spite  of  cookery  hav- 
ing concealed  some  of  its  repulsiveness.  High  game  has  fortu- 
nately gone  out  of  fashion,  and  the  most  frequent  form  in  which 
we  now  meet  with  decomposing  albuminoid  matter  is  that  of  a 
fusty  egg.  Some  housekeepers  seem  to  consider  this  quite  good 
enough  for  made  dishes,  and  thus  spoil  material  worth  ten  times 
what  they  save  by  their  nasty  economy.  No  egg  should  be  al- 
lowed to  enter  the  kitchen,  that  has  the  slightest  smell  of  rotten 
straw.  But  this  seems  rather  beyond  the  subject  of  butcher's 
meat,  and  it  is  time  to  proceed  to  another  department  of  the  lar- 
der. The  suitability  of  different  sorts  of  meat  to  different  consti- 
tutions will  be  considered  in  a  future  chapter. 

§  2.  POULTRY  AND  GAME. 

Tenderness  is  the  chief  virtue  in  poultry,  and  is  most  difficult 
to  find  in  the  winter  season.  Spring  chickens  come  in  with  May, 
but  during  the  five  previous  months  much  care  is  requisite  in 
purchasing  this  article  of  the  table.  A  young,  and  therefore 
tender  bird,  may  be  known  before  plucking  by  the  comparative 


40  GENERAL    DIETETICS. 

\ 

largeness  of  the  feet  and  the  leg  joints.  And  when  a  fowl  ap- 
pears at  table  with  a  thin  neck  and  violet-tinted  thighs,  it  is  wise 
to  avoid  being  helped  to  the  leg.  These  are  invariable  signs  of 
age  and  toughness. 

The  same  violet  tinge  may  be  noticed  in  the  thighs  of  old  tur- 
keys, which  are  also  distinguished  by  their  hairiness.  The  age  of 
ducks  and  geese  may  be  tested  by  their  beaks,  the  lower  part  of 
which  breaks  away  easily  in  youth. 

Besides  being  tough  and  indigestible,  an  old  fowl  has  a  rank 
flavor,  like  a  close  hen-house,  which  arises  from  the  absorption 
into  its  flesh  of  the  oil  furnished  by  nature  to  lubricate  the  feath- 
ers. This  is  still  more  perceptible  in  old  ducks  and  geese.  It 
may  often  be  tasted  some  time  after  a  meal,  and  must  therefore, 
like  most  rank  oils,  arrest  digestion. 

Game  may  roughly  be  selected  by  the  same  rules  as  poultry. 
Those  who  have  interested  themselves  in  ornithology  may  also 
get  some  help  from  observing  the  undeveloped  spurs  in  young 
gallinaceous  birds,  and  the  pointed  long  wing-feathers  of  the 
young  partridge,  which  become  rounded  at  the  tip  when  he  is 
old. 

Poultry  should  not  be  too  fat.  In  cooking,  the  oily  adipose 
tissue  becomes  rank,  and  is  less  digestible  than  the  fat  of  mam- 
malia. 

§  3.  FISH. 

The  sanitarian  has  not  much  advice  to  give  concerning  the 
marketing  of  raw  fish,  except  that  it  should  be  fresh.  The  guides 
by  which  to  judge  of  this  are  the  fulness  of  the  eyeballs,  and  the 
bright  pink  hue  of  the  gills.  The  sense  of  smell  cannot  be 
trusted  to,  as  it  may  be  deceived  by  the  use  of  ice.  When  cooked, 
the  flesh  of  fresh  fish  is  firm  but  friable ;  that  which  is  stale  is 
flabby  and  stringy,  even  if  preserved  by  cold  from  actual  putre- 
faction. 

The  less  salt,  and  the  colder  the  water  is  whence  our  fish 
comes,  the  better  adapted  is  it  for  the  table.  At  Gibraltar  it  is 
not  hard  to  distinguish  the  mullet  caught  on  the  Atlantic  side  of 
the  rock  from  that  which  lives  in  the  Mediterranean,  a  warmer 
and  more  concentrated  sea ;  so  much  is  the  advantage  on  the  side 
of  the  former.  An  Icelander  dining  at  my  house  passed  by  with 


ON    THE    CHOICE    OF    FOOD.  41 

polite  scorn  a  piece  of  prime  Scarborough  cod.  Seeing  my  sur- 
prise, he  explained  that  no  one  who  has  tasted  it  at  Reikiavik 
could  bear  to  eat  cod  in  England,  and  that  it  was  best  in  the 
polar  circle,  braced  up  by  the  melting  icebergs.  The  nearly 
fresh  waters  of  Loch  Fyne  supply  the  choicest  herrings,  and  the 
pure  light  mountain  streams  a  better  trout  than  our  lowland 
streams,  where  the  atmospheric  pressure  is  greater. 

Every  sort  is  best  when  it  is  cheapest,  for  then  it  is  most  plen- 
tiful and  in  fullest  season.  It  is  a  wise  plan  to  contract  with 
your  fishmonger  to  send  you  so  many  dishes  a  week  at  a  fixed 
sum,  and  then  it  becomes  his  interest  to  supply  that  with  which 
the  market  most  abounds.  For  healthy  persons,  every  kind  or- 
dinarily exposed  for  sale  in  England  is  wholesome,  provided  it  be 
good  of  its  kind,  and  not  spoilt  in  the  cooking.  The  selection  of 
fish  for  invalids  will  be  discussed  later. 

Complete  cookery,  however,  should  be  insisted  upon.  The 
conger-eel,  for  example,  is  a  very  foul  feeder,  and  has  been  known, 
if  carelessly  grilled,  to  cause  diarrhoea,  probably  from  the  fetid 
contents  of  the  stomach  saturating  the  flesh.  And  at  the  Patho- 
logical Society  on  May  5,  there  was  shown  a  specimen  of  the 
bunch-headed  tapeworm  (Bothriocephalus  latus)  which  had  grown 
in  a  person  used  to  eat  half-cooked  fresh-water  fish. 

The  only  sort  of  reptile  of  dietetic  importance  is  the  turtle.  It 
is  sometimes  viewed  as  a  mere  luxury,  but  is  in  reality  a  most 
digestible  and  nutritious  food,  and  if  more  demanded  wrould 
quickly  become  more  plentiful  in  the  market.  The  creature 
grows  too  slowly  for  it  ever  to  remunerate  artificial  culture,  but 
nature  supplies  it  in  immense  quantities,  and  its  tenacity  of  life 
enables  it  to  be  brought  over  alive  from  the  tropics.  Fresh  turtle 
is  much  more  costly  than  it  ought  to  be,  but  the  rival  importation 
of  dried  turtle  fins  is  reducing  the  price.  This  last-named  article 
is  of  great  value,  and  of  moderate  price ;  from  it,  first-rate  real 
turtle-soup  may  be  made  at  no  more  than  the  expense  of  mock- 
turtle,  if  we  deduct  the  price  of  the  wine  used,  which  to  some 
palates  is  no  improvement.  The  fins  should  be  soaked  for  at 
least  twenty -four  hours  before  cooking. 

Caviare,  the  roe  of  the  sturgeon,  is  best  obtained  from  a  fish- 
monger. The  dealer  in  preserved  provisions  seems  to  think  it  all 
the  better  for  being  preserved,  whereas  it  should  be  as  fresh  as 


42  GENERAL    DIETETICS. 

can  be  got,  exhibiting  its  freshness  by  its  softness  and  light  color. 
That  black,  hard  sort  of  fish-jam  which  is  sometimes  served  up, 
is  really  unfit  for  human  consumption. 

All  that  has  been  said  above,  applies  equally  to  Crustacea  and 
shells;  but  an  additional  remark  maybe  made  about  crabs.  They 
should  be  cleansed  scrupulously  before  cooking,  and  if  that  which 
is  removed  from  their  prehensile  organs  is  fetid,  they  are  hardly 
to  be  considered  safe.  The  frequency-  with  which  crabs  disagree 
unexpectedly  with  a  healthy  stomach,  may  be  attributed  with 
reason  to  the  garbage  on  which  the  creature  lives.  And  of  oysters 
it  should  be  remembered  that  they  are  to  be  eaten  raw,  or,  at 
most,  barely  warmed  through ;  for  complete  boiling  makes  the 
flesh  tough,  so  that  it  is  prudent,  if  they  come  from  near  river- 
mouths,  to  keep  them  alive  in  a  shallow  dish  of  clean  brine  for  a 
day  or  two,  feeding  them  with  meal,  and  changing  the  water  so 
as  to  leave  them  bare  twice  a  day,  in  imitation  of  the  tide.  They 
become  peculiarly  plump  and  wholesome  under  this  management. 

§  4.  GARDEN  PRODUCE. 

The  commonest  fault  committed  by  housekeepers  in  respect  of 
vegetables,  is  that  they  do  not  supply  a  sufficient  variety,  seeming 
to  consider  that  the  meat  is  the  only  part  of  the  meal  that  re- 
quires care,  and  that  all  the  rest  is  mere  garnish,  beneath  the  no- 
tice of  a  Briton,  and  unfit  to  sustain  his  vigorous  life.  Yet  that 
is  not  the  experience  of  the  observers  of  mankind.  The  attention 
of  Herodotus  was  called  to  the  fact  that  the  Persians,  the  man- 
liest and  most  sporting  nation  in  the  old  world,  had  at  meals  not 
only  several  dishes,  but  several  courses  of  vegetable  food,  preced- 
ing a  very  moderate  allowance  of  solid  meat.1  And  Sir  Henry 
Kawlinson  describes  the  diet  of  this  tough  race  as  practically  the 
same  now,  so  that  the  assumptions  of  some  anthropologists  that 
hunting  races  are  necessarily  riotous  eaters  of  flesh,  and  that  car- 
nivoracity  strengthens  a  nation,  are  not  accurate.  The  Persian 
gentleman  is  the  spiritual  father  of  the  British  squire  f  yet,  at 

1  Herodotus,  Clio,  cxxxiii. 

2  He  taught  his  sons  "to  shoot,  to  ride,  to  speak  the  truth,"  and  then  left 
them  to  educate  themselves ;  he  was  devoted  to  his  sovereign  to  a  degree  that 
astonished  Herodotus ;  and  he  loved  a  good  glass  of  wine  in  good  company. 


ON    THE    CHOICE    OF    FOOD.  43 

many  a  hospitable  board,  if  a  guest  does  not  fancy  meat  that  day, 
or  lias  eaten  enough  of  it  at  a  previous  meal,  he  will  have  to  fall 
back  upon  potatoes,  or  to  solace  himself  by  picking  a  few  bits  out 
of  the  sauces  of  made  dishes,  where  the  vegetable  flavor  has  been 
saturated  with  that  of  meat  and  spoilt.  Usually,  he  goes  on  eat- 
ing too  much  nitrogenous  food  out  of  sheer  idleness. 

Another  fault  is  that  the  vegetables  are  not  sufficiently  fresh. 
Unhappily  dead  plants  do  not  stink  early  enough  to  disgust  the 
nose;  but  yet,  every  minute  they  are  kept  after  their  actual  death, 
that  is  to  say,  after  they  have  ceased  to  be  capable  of  growth, 
renders  them  in  some  degree  less  digestible.  Sometimes  they  are 
kept  too  long  out  of  mere  carelessness,  sometimes  from  lack  of 
sale,  but  sometimes  also  intentionally,  to  make  them  look  better 
at  table.  For  a  long  time,  I  could  not  make  out  why  London 
asparagus  so  often  disagreed  with  people,  till  at  last  I  caught  a 
gardener  cutting  it  twenty-four  hours  before  it  was  wanted,  and 
putting  it  in  a  damp  warm  frame,  "to  swell,"  as  he  said.  Cu- 
cumbers and  broccoli  are  often  spoilt  in  the  same  way.  The  vast 
wagons  of  cabbage  that  one  sees  coming  into  London  at  midnight 
are  often  the  bearers  of  two  or  three  days'  cutting  in  small  gar- 
dens, kept  till  a  full  load  is  accumulated  for  a  single  journey;  as 
early  travellers  by  rail  may  see  for  themselves.  Sprinkled  with 
water  they  look  well,  but  never  regain  their  fresh  character.  They 
ferment  in  the  stomach,  and  produce  flatulence. 

Potatoes. — The  virtues  of  a  potato  are  to  be  mealy  and  pow- 
dery when  boiled,  and  to  mash  readily  into  a  smooth  puree.  This 
shows  that  the  starch-granules  are  in  a  healthy  condition,  and 
that  they  absorb  water  and  burst  the  envelopes  of  glutinous  matter 
which  the  heat  has  coagulated.  Young  potatoes,  from  not  so 
easily  breaking  up,  require  long  mastication  to  render  them  solu- 
ble, and  are  not  then  very  digestible.  But  old  waxy  potatoes  are 
worse,  for  they  seem  to  unite  again  into  a  sticky  mass,  after  being 
swallowed,  and  remain  for  hours  undissolved;  the  worst  of  all  are 
potatoes  affected  by  the  peculiar  epidemic  called  after  their  name. 
The  diseased  part,  looking  as  if  it  were  stained  with  a  drop  of  ink, 
remains  quite  hard  in  spite  of  any  amount  of  boiling  and  digest- 
ing: eating  it  is  equivalent  to  eating  so  much  rotten  wood.  Pota- 
toes which  have  begun  to  sprout,  are  also  indigestible,  and  frosted 


44  GENERAL    DIETETICS. 

potatoes  begin  to  decay  immediately  a  thaw  sets  in.  The  best 
potatoes  are  "Regents." 

Jerusalem  Artichokes  are  largely  used  in  England  by  people 
who  have  gardens,  partly  because  the  plant  is  handsome,  and 
partly  because  the  root  is  not  injured  by  frost,  and  so  can  be  al- 
lowed to  remain  in  the  earth  during  winter.  The  dried  stem  is 
also  convenient  for  firing.  It  is  a  watery  vegetable,  and  though 
it  had  the  start  of  the  potato  in  European  horticulture,  it  has  never 
been  brought  to  the  same  perfection.  The  fact  is  it  contains  no 
starch,  and  the  "  inulin  "  which  replaces  that  valuable  aliment, 
is  only  2  per  cent,  of  its  weight,  whereas  in  its  successful  rival  there 
is  a  proportion  of  16  per  cent.  It  should  be  eaten  only  as  an  oc- 
casional change,  for  the  sake  of  its  flavor. 

Turnips  may  have  nearly  the  same  things  said  of  them. 

Yams  and  sweet  potatoes  come  now  into  the  London  market. 
They  are  as  mealy  and  wholesome  as  the  commoner  tuber,  and 
are  sometimes  useful  to  tempt  our  patients  into  the  use  of  vegeta- 
ble diet. 

Carrots  contain  a  quantity  of  pectin,  which  can  be  extracted 
from  them  in  the  form  of  a  jelly,  and  is  often  used  by  confectioners 
to  mix  with  fruit  jelly  as  a  diluent.  It  resides  principally  in  the 
outer  rind,  whose  thickness  therefore  in  proportion  to  the  pale  core 
is  a  test  of  the  goodness  of  the  specimen.  When  soft  and  friable 
they  are  much  more  nutritious  than  turnips. 

Parsnips  may  take  to  themselves  the  same  praise,  and  ought  to 
be  more  used,  especially  with  boiled  fish.  From  their  sweetness 
they  make  excellent  fritters,  and  are  liked  by  children,  to  whom 
they  are  well  adapted.  However,  when  old  and  stringy,  they 
should  be  avoided. 

Salsify  is  in  England  considered  more  a  dish  for  the  gourmet, 
than  as  a  food  for  middle-class  tables.  This  is  unjust,  for  it  is 
nutritious  and  digestible,  and  grows  easily.  It  is  best  eaten  alone, 
fried  in  a  thin  coat  of  batter.  It  should  break  readily,  and  be 
free  from  strings. 

Leeks  make  a  capital  soup  and  a  most  digestible  side  dish.  The 
more  white  there  is  in  them,  and  the  less  green,  the  softer  and 
better  they  are.  They  should  have  but  little  smell. 

Sea-kale  should  be  perfectly  blanched.     When  colored  it  is  in- 


ON    THE    CHOICE    OF    FOOD.  45 

digestible,  as  is  shown  by  its  being  tasted  in  the  mouth  after 
dinner. 

Asparagus  should  be  eaten  as  soon  as  possible  after  cutting,  and 
then  it  is  most  wholesome.  The  greenest  asparagus  is  that  which 
contains  the  greatest  amount  of  the  active  principles,  bitter  and 
resinous,  and  is  therefore  to  be  chosen  in  preference.  I  have 
known  timid  patients  to  fear  that  it  must  be  injurious  to  the  kid- 
neys, because  of  the  peculiar  odor  communicated  by  it  to  the 
urine.  It  certainly  does  no  harm,  and  I  doubt  almost  if  it  is  a 
diuretic. 

In  early  spring,  the  fresh  young  fronds  of  the  male  fern  make 
a  good  imitation  of  early  asparagus,  and  are  decidedly  better  than 
the  wild  asparagus  brought  to  table  in  the  south  of  Europe.  With 
other  substitutes  for  it  I  have  no  acquaintance.  The  number  of 
them  shows  how  well  worth  having  the  real  thing  is. 

Cabbage  is  the  most  valuable  antiscorbutic  we  possess.  In  the 
slight  degree  of  scorbutus  characterized  by  bleeding  of  the  gums 
or  by  purpura,  it  is  eminently  successful,  and  prevents  the  same 
thing  happening  to  other  members  of  the  household  who  are  wise 
enough  to  prefer  prevention  to  cure.  It  should  be  soft  but  crisp 
before  cooking,  and  show  no  signs  of  having  been  wetted.  If  it 
has  begun  to  heat  from  incipient  fermentation,  it  is  most  noxious, 
and  generates  in  the  intestinal  canal  an  enormous  amount  of  flatus, 
consisting  not  only  of  the  usual  carbonic  acid,  but  of  sulphuretted 
hydrogen  as  well.  Fermentation  destroys  the  antiscorbutic  quali- 
ties of  the  cabbage,  for  sour-crout  is  not  nearly  so  efficacious  as  the 
fresh  plant. 

Sour-crout  is  prepared  by  taking  advantage  of  the  fermentation 
as  a  means  of  afteivpreservation.  The  leaves  of  the  kail  are  al- 
lowed to  heat,  and  then  subjected  to  severe  pressure,  which  arrests 
the  chemical  action,  and  hardens  them  into  a  dry  mass,  which  will 
keep  a  long  time.  It  requires  much  soaking,  and  should  not  be 
cooked  till  free  from  all  sour  taste.  It  should  not  want  chewing, 
or  it  is  shown  to  be  underdone. 

The  best  sorts  are  the  old  white  garden  cabbage  and  the  summer 
cauliflower. 

Winter  greens  are  of  so  many  sorts  that  it  would  be  necc,-~;iry 
to  be  a  complete  gardener  to  give  rules  for  the  selection  of  each. 
Their  greenness  and  freshness  at  a  time  when  all  around  is  brown 


46  GENERAL    DIETETICS. 

and  decaying  is  the  attraction  to  them ;  and  it  may  be  said  gener- 
ally, that  therefore  they  ought  to  be  as  fresh  and  green  as  possible. 
Under  this  heading  I  include  savoys  and  Brussels  sprouts,  but 
not  broccoli,  which  should  of  course  be  as  white  as  can  be  got. 

I  take  the  opportunity  of  having  to  allude  to  kohl-rabi  (a  new 
kind  of  cabbage  of  which  the  leaf-stalks  are  eaten),  to  say  that  it 
is  not  prudent  to  recommend  to  our  patients  novel  varieties  of 
garden  produce,  unless  we  are  well  acquainted  writh  them  our- 
selves. We  do  not  know  how  to  decide  if  they  are  good  of  their 
sort  or  not;  and  much  more  depends  upon  that  than  upon  the  kind 
of  vegetable. 

Cardoons. — Those  who  grow  this  delicious  thistle,  which  is  sel- 
dom brought  to  market,  should  take  care  that  the  leaf-stalks  are 
at  least  an  inch  and  a  half  thick  before  they  are  considered  fit  for 
cutting. 

The  artichoke  is  another  thistle,  like  the  last-named,  of  an  orna- 
mental character,  and  more  cultivated  in  this  country.  Eaten 
raw,  or  only  just  warmed,  as  is  common  in  France,  it  is  as  indi- 
gestible as  nuts,  which  it  much  resembles  ;  but  well  boiled  till  it 
is  quite  soft,  it  may  be  eaten  with  impunity  even  by  invalids. 
After  an  early  dinner  it  makes  a  good  dish  for  supper. 

Chestnuts  are  a  very  good  substitute  for  potatoes  with  white 
meat  or  fowl.  They  should  be  thoroughly  well  boiled,  skinned, 
and  served  up  in  a  hot  dry  napkin.  Home-grown  chestnuts  are 
the  best,  being  more  mealy  and  powdery  than  those  imported.  A 
sweet  soup  also  may  be  made  of  ch'  stnuts  rubbed  through  a  sieve ; 
but  I  cannot  recommend  the  polenta  cake  and  bread  made  of  this 
nut,  which  are  so  popular  in  Italy.  It  requires  a  long  education 
to  accustom  the  digestion  to  them. 

Vegetable  marrow,  squash,  elector's  cap,  and  a  few  other  sorts  of 
pumpkin  are  wholesome  diluents,  but  do  not  form  a  substantive 
diet.  The  same  may  be  said  of  the  tomato.  Care  should  be  taken 
that  they  are  ripe,  or  they  cause  colic. 

Peas  and  broad  beans  should  be  young,  and  their  skins  tender 
enough  to  crack  in  boiling.  If  they  are  past  the  time  of  life  for 
this  to  happen,  they  should  be  chopped,  mashed,  or  otherwise 
broken  up;  for  the  unbroken  skins  are  very  leathery.  The  longer 
they  are  boiled,  the  harder  they  get. 

Dried  peas,  split  peas,  are  deprived  of  their  skins  already ;  so 


ON    THE    CHOICE    OF    FOOD.  47 

that  if  well  boiled,  as  in  soup  or  pudding,  they  are  very  good  for 
food  for  robust  people. 

It  appears  wasteful  to  throw  away  the  outer  shell  of  the  pea.  It 
contains  a  great  deal  of  nutritious  matter,  but  it  is  not  nice  in  the 
commoner  sorts.  There  has  been  lately  introduced  a  new  pea,  the 
shell  of  which  is  edible,  and  seems  wholesome. 

French  beans,  from  the  kidney  bean  and  scarlet  runner,  are  still 
more  required  to  be  young  and  tender. 

White  beans  are  the  ripe  seeds  of  the  same  plants.  They  are 
not  popular  in  England,  apparently  because  they  do  not  blend 
well  as  an  adjunct  to  meat.  But  eaten  alone  with  a  piquant 
sauce,  they  are  a  most  palatable  variety  of  dish,  and  certainly 
nutritious. 

Lentils,  again,  are  too  much  neglected.  They  make  a  capital 
soup,  resembling  pea  soup.  The  peculiar  flavor  of  lentil  flour, 
which  is  distatefnl  to  some  persons  (reminding  them  of  garden 
seeds,  they  say),  may  be  masked  by  adding  to  it  some  sugar  and 
Indian  corn  flour  or  fine  barley  meal.  Or  if  it  is  wanted  for  soup, 
a  few  bits  of  celery  or  asparagus  cover  the  objectionable  taste 
completely.  It  is  sold  under  the  name  of  revalenta  arabica  at  a 
higher  price  considerably  than  is  charged  for  it  as  lentil  flour  at 
a  corn-dealer's. 

Mushrooms  are  best  when  grown  in  an  open  meadow.  When 
forced  they  are  tough  and  indigestible,  and  when  preserved  they 
are  tasteless  as  well.  A  meadow  mushroom  should  peel  easily, 
and  it  should  be  of  a  clean  pink  color  inside,  like  a  baby's  hand, 
and  have  a  frill  or  "curtain"  (as  botanists  call  it)  attached  to  the 
stalk.  When  the  gills  are  brown  they  are  growing  old  and  dry, 
and  losing  their  nutritive  qualities.  The  above-described  agaricus 
campcstris  is  the  queen  of  its  class  for  cooking  purposes  in  Eng- 
land. It  is  true  there  are  several  other  similar  fungi  eatable,  and 
eaten  by  experimentalists ;  but  my  experience  of  them  is  that  their 
flavor  is  inferior,  and  that  we  lose  nothing  by  the  safe  rule  of  ad- 
hering to  the  one  we  know  well  by  sight. 

The  Gigantic  Puff  ball  makes  excellent  ketchup,  and  can  be 
eaten  in  the  shape  of  fritters.  It  must  be  large  and  very  white, 
like  a  great  bleached  skull.  When  discolored  it  is  beginning  to 
ripen  its  spores,  and  is  then  poisonous. 

The  morellc,  the  fan-shaped  chanterelle,  and  the  black  truffle 


48  GENERAL    DIETETICS. 

should  be  sweet  and  fresh.  The  odor  of  the  last-named  when  de- 
composed is  so  horrible  that  one  can  hardly  fancy  its  being  toler- 
ated ;  yet  I  have  known  a  cook  use  truffles  in  this  state,  and  say 
she  thought  it  was  the  right  smell. 

Materials  for  Salad. — Here  again,  as  in  the  case  of  winter 
greens,  the  plants  used  are  so  many  and  various  that  to  enumerate 
them  would  be  as  tedious  as  useless,  and  to  describe  their  several 
tests  of  salubrity  would  require  more  horticultural  knowledge 
than  I  possess.  Repelled  by  the  barbarous  and  barren  aspect  of 
a  list  of  their  technical  names,  I  was  comforted  by  the  recollection 
of  a  scene  of  long  ago.  A  party  of  young  gentlemen  and  ladies 
were  earnestly  disputing  about  the  nomenclature  and  specific  differ- 
ences of  certain  plants,  and  appealed  to  grandpapa,  an  elderly 
Parisian  ;  he  settled  the  matter  in  a  moment — "  JEh,  mes  chers,  ce 
sont  des  salades"  I  shall  imitate  him  in  condensing  them  into  a 
class. 

Vegetables  intended  to  be  used  for  salad  should  all  be  fresh  and 
crisp,  and  sweet  and  clean.  Their  colors  should  be  positive  and 
even,  the  reds  very  red,  the  wrhites  very  white,  and  the  greens 
pure  as  those  in  an  autumn  sunset  sky,  except  in  the  full-grown 
leaves,  such  as  watercress.  The  salad  ought  to  be  dressed  by  one 
of  the  daughters  of  the  house,  after  she  has  herself  dressed  for 
dinner,  singing,  if  not  with  voice,  with  her  clean  cool  fingers, 
sharp  silver  knife,  and  wooden  spoon, 

"  Weaving  spiders,  come  not  here; 

Hence,  you  long-legged  spinners,  hence  : 
Beetles  black,  approach  not  near  ; 
Worm  nor  snail,  do  no  offence." 

The  purity  of  the  bowl  is  more  important  than  that  of  Titania's 
bower.  So  will  the  guests  eat  it  with  light  hearts,  free  from  all 
fears  of  noxious  ingredients. 

With  a  little  trouble,  not  however  necessarily  attended  by  ex- 
pense, a  succession  may  be  provided  of  materials  for  salad  all  the 
year  round,  so  as  to  have  one  at  table  every  day.  And  a  great 
preservative  of  health  I  believe  it  to  be  for  hearty  persons.  The 
most  difficult  season  to  provide  for  is  the  latter  end  of  the  winter, 
and  it  may  be  of  use  to  mention  that  the  dandelion  is  then  a  friend 
in  need.  If  a  pot  be  placed  over  the  plant  as  it  grows,  or  the 


ON    THE    CHOICE    OF    FOOD.  49 

leaves  tied  up  like  lettuce,  or  it  be  transplanted  into  a  frame,  it 
can  be  bleached,  and  thus  loses  its  bitterness.  Daisy  leaves  are 
also  eatable ;  and  thus  with  a  sprig  of  tarragon,  a  few  cold  pota- 
toes, and  some  ever-constant  mustard  and  cress,  giant  cress,  Aus- 
tralian or  curled  cress,  an  olive  or  two  pared  thin,  or  some  beet- 
root and  a  slice  of  Madeira  onion,  a  great  variety  of  combinations 
may  be  made.  Indeed,  an  inventive  lady,  with  a  well-furnished 
cruet  stand,  a  bottle  of  Worcester  sauce,  and  some  moutarde  de 
Ma  Hie,  might  provide  a  different  salad  every  day  of  the  year. 
These  "scratch"  salads  are  very  much  improved  by  a  table- 
spoonful  of  light  white  wine.  Watercresses  rather  spoil  salad,  and 
are  best  eaten  alone,  so  as  to  make  a  variety  when  nothing  else 
can  be  obtained.  And  the  same  may  be  said  of  radishes,  and  of 
endive,  which  are  too  strong  in  flavor  to  combine  well. 

Some  persons  are  very  fond  of  tomatoes  sliced  raw,  and  eaten 
as  a  salad  with  oil  and  vinegar.  They  appear  to  be  quite  digesti- 
ble in  this  state,  if  ripe. 

Celery  and  cucumber  raw  are  not  suitable  for  eating  after  a 
heavy  meal.  The  quantity  of  woody  fibre  in  them  adds  an  ad- 
ditional load  to  the  stomach,  at  a  time  when  all  its  powers  are 
required.  With  bread  and  cheese,  as  a  light  lunch,  they  give  an 
agreeable  zest,  and  seem  to  stimulate  the  secretion  of  gastric  juice. 
That  is  the  time  for  their  admirers,  and  they  are  many,  to  enjoy 
them. 

The  selection  of  mere  flavoring  herbs,  such  as  onions,  garlic, 
mint,  tarragon,  etc.,  is  not  a  matter  for  the  dietician  to  discuss. 
He  may,  however,  say  one  word  in  favor  of  temperance  in  their 
employment.  An  excess  makes  us  unpleasant  to  our  neighbors ; 
and  disguising  the  true  flavor  of  the  meat,  it  leads  to  our  putting 
up  with  an  inferior  article.  The  object  to  be  aimed  at  in  their  use 
is  to  promote  the  secretion  of  digestive  solvents ;  and  the  degree 
in  which  they  attain  this  object  may  be  judged  by  the  watering  of 
the  mouth  ;  a  whiff  of  them  excites  the  flow  of  saliva,  a  copious 
dose  runs  it  dry. 

The  produce  of  the  kitchen  garden,  classed  according  to  the 
main  objects  which  its  use  serves,  may  be  divided  as  follows,  the 
order  adopted  in  each  class  being  a  rough  estimate  of  the  plant's 
average  value  as  an  esculent. 

4 


50  GENERAL    DIETETICS. 

1.  Starchy   and  sugary  plants. — Potatoes,   white   and  sweet, 
yams,  chestnuts,  beans,  lentils,  peas,  Jerusalem  artichokes,  carrots, 
parsnips,  beet-root,  salsify,  turnips. 

2.  Stimulants. — Asparagus,    wild    onions,    artichokes,    strong 
onions,  garlic,  and  other  substitutes,  aromatic  herbs  and  other 
flavors,  mustard,  cress,  and  a  few  other  pungent  salad  materials. 

3.  Antiscorbutics. — Cabbages,  tomatoes,  and  salad  materials  iu 
general. 

4.  Diluents. — Cabbages,  spinach,  turnip-tops,    winter   greens, 
broccoli,  cauliflower,  Brussels  sprouts,  sorrel,  nettle-tops,  and  in 
short  any  leaves  sufficiently  palatable  to  eat  and  soft  to  swallow, 
which  are  green  when  boiled. 

The  use  of  the  first  class  is  obvious  from  the  powers  assigned  to 
starch  and  sugar  by  the  investigations  quoted  in  the  last  chapter. 
Each  of  these  vegetables  is  a  direct  food  contributing  to  the  force 
of  the  body  in  health.  How  under  certain  circumstances  some, 
or  all,  become  unsuitable,  will  be  spoken  of  in  a  future  part  of 
the  volume. 

The  effect  of  stimulating  vegetables  is  to  cause  an  increased  se- 
cretion of  saliva  and  gastric  juice,  thus  enabling  a  greater  quan- 
tity of  food  to  be  dissolved. 

Antiscorbutics  seem  to  act  by  contributing  some  of  the  mate- 
rials of  the  blood  of  lesser  amount,  though  of  importance  to  the 
general  vigor  of  the  constitution.  Herodotus  implicitly  attrib- 
utes the  activity  and  healthiness  of  the  Persian  race  to  the  va- 
riety of  fruit  and  vegetables  consumed  by  them.  And  I  feel 
sure  that  the  puniness,  infertility,  pallor,  fetid  breath,  and  bad 
teeth,  which  distinguish  some  of  our  town  populations,  is  to  a 
great  extent  due  to  their  inability  to  get  these  articles  of  the  table 
fresh.  The  watercress  seller  is  one  of  the  saviours  of  her  country. 
The  consumption  of  lettuce  with  his  tea  is  an  increasing  habit 
worthy  of  all  encouragement  in  the  working  man,  but  he  must 
be  warned  of  the  importance  of  washing  the  material  of  his  meal. 

The  last  hint  is  given  in  view  of  the  frequency  of  the  occur- 
rence of  the  large  "  round  worm  "  ( Ascaris  lumbricoides]  in  the 
laboring  population  of  some  agricultural  counties,  such  as  Ox- 
fordshire, for  example,  where  unwashed  lettuce  is  often  eaten  at 
this  meal.  Naturalists  will  not  allow  us  to  think  that  the  crea- 
ture is  a  lob-worm,  altered  by  its  birth  in  an  abnormal  habitat. 


ON    THE    CHOICE    OF    FOOD.  51 

But  at  all  events  its  ova  will  live  for  years  in  moist  earth,1  and 
may  easily  be  brought  in  from  the  garden,  which  has  been 
manured  from  all  sources. 

Diluents  contain  a  large  proportion  of  woody  fibre  and  chloro- 
phyll, which  are  little,  if  at  all,  soluble  in  the  secretions  of  the 
stomach,  and  are  not  converted  into  sugar  by  the  saliva,  as  starch 
is.  And  they  are  not  liable  to  be  removed  by  absorption  like 
Avatcr,  the  most  universal  diluent.  Their  use  would  appear  to  be 
to  get  mixed  up  witli  the  nitrogenous  articles  of  food,  so  that  the 
mass  may  be  permeated  by  the  gastric  juice  and  presented  gradu- 
ally to  the  absorbents.  Like  gelatin,  though  apparently  not  nu- 
tritious themselves,  they  make  other  things  nutritious.  Their 
benefit  is  made  manifest  by  the  improved  action  of  the  bowels 
after  their  employment. 

§  5.  FRUIT. 

Fruit  is  hardly  ever  eaten  except  because  it  is  nice.  A  very 
good  reason  no  doubt,  but  one  that  rather  removes  the  considera- 
tion of  the  subject  from  the  scope  of  the  dietician. 

The  safest  time  for  taking  fruit  is  in  the  morning  or  afternoon 
with  stale  bread  and  a  draught  of  water.  Thus  may  be  made  a 
very  wholesome  and  digestible  lunch.  The  worst  time  is  after  a 
heavy  dinner.  Adults  often  complain  that  they  cannot  enjoy 
fruit  as  their  girls  and  boys  do ;  the  fact  is  they  eat  it  at  a  wrong 
hour  of  the  day. 

Grapes,  figs,  peaches,  cherries,  oranges,  and  strawberries,  may 
be  considered  to  be  the  most  digestible;  plums,  apples,  pears,  and 
apricots  are  less  so ;  while  melons,  and  other  cold  watery  things, 
are  not  only  indigestible  themselves,  but  prevent  digestion. 

In  selecting  oranges,  especially  for  our  patients,  it  is  best  to 
take  those  with  the  greenish  calyx  still  adhering  to  them ;  they 
are  the  juciest  and  ripest.  The  fewer  pips,  the  better  the  orange, 
or  lemon,  or  grape. 

Nuts  and  almonds  have  not  justice  done  them  by  nature.  They 
contain  an  enormous  proportion  of  a  valuable  nitrogenous  aliment, 
which  in  the  latter  exceeds  half  its  weight,  and  is  called  "  emul- 

1  Davaine,  quoted  in  Keynolds's  System  of  Medicine,  vol.  iii,  p.  194. 


52  GENERAL    DIETETICS. 

sin  "  from  its  diffusibility  without  solution  in  water ;  yet  this  is 
so  cut  off  by  its  natural  concentration  and  hardness  from  the  ac- 
tion of  the  gastric  juice,  that  it  is  scarcely  digested  at  all,  unless 
chewed  and  cooked  much  more  than  usual.  When  chosen  for 
food,  they  should  be  used  in  extreme  moderation,  and  at  a  time 
when  the  stomach  is  at  leisure,  and  can  devote  all  its  powers  to 
their  solution.  When  pounded  and  employed  as  a  flavoring,  they 
are  innocent  enough.  Frying  them  with  butter,  salt,  and  pepper, 
makes  a  tasty  and  wholesome  hot  dish  for  dessert. 

Cookery,  breaking  up  the  texture  of  all  fruit,  makes  it  much 
more  easy  of  digestion. 

The  Jews,  who  eat  much  fruit,  assign  that  habit  as  a  reason 
why  their  people  suffered  less  than  others  from  cholera,  during 
recent  invasions  of  the  epidemic.  But  it  may  be  remarked  that 
they  sell  a  good  deal  of  fruit,  as  well  as  eat  it,  and  may  possibly 
be  prejudiced  in  favor  of  the  trade.  It  can  hardly  be  wise  to 
consume  more  fruit  than  usual,  at  a  time  when  a  chance  looseness 
of  bowels  is  often  the  exciting  cause  of  a  fatal  affection  of  the 
system,  excited  by  the  special  poison  then  prevalent. 

§  6.  GROCERIES  AND  CHANDLERY. 

Recent  legislation  about  adulteration  has  been  directed  more 
against  the  grocer  than  against  any  other  of  our  purveyors.  The 
stores  he  sells  have  all  gone  through  a  process  of  manufacture 
which  alters  their  natural  aspect,  and  therefore  gives  great  facility 
to  fraud.  The  fraud  consists  in  mixing  a  cheaper  substance  with 
a  more  expensive,  and  disguising  the  mixture.  The  disguise  may 
be  deleterious  to  health,  or  it  may  not,  or  it  may  even  make  the 
compound  more  wholesome,  but  the  fraud  is  the  same.  In  these 
pages,  however,  we  have  to  do  only  with  those  adulterations 
which  render  the  goods  less  fit  for  consumption  as  food. 

The  line  will  be  taken  of  shortly  pointing  out  the  characteris- 
tics of  the  best  articles,  without  attempting  to  enumerate  the 
sophistications  to  which  they  might  possibly  be  subjected,  but 
against  which  the  possession  of  good  characteristics  practically 
warrants  them.  To  detect  the  special  method  by  w*hich  bad  gro- 
ceries are  made  bad,  requires  the  detector  to  be  as  acute  as  the 
rogue  he  is  trying  to  expose ;  and  unless  he  makes  that  his  sole 


ON    THE    CHOICE    OF    FOOD.  53 

ambition  in  life,  he  is  not  likely  to  succeed.  Money-making  is  a 
much  stronger  stimulus  to  invention  than  the  love  of  truth.  If  a 
customer  suspects  adulteration,  he  will  act  wisely  to  place  the 
matter  in  the  hands  of  the  legally  established  analyst  of  his  dis- 
trict, the  expense  of  the  proceeding  being  now  made  very  mod- 
erate.1 

Tea.2 — The  uses  of  tea  are — 

1st.  To  give  an  agreeable  flavor  to  warm  water  required  as  a 
drink. 

2d.  To  soothe  the  nervous  system  when  it  is  in  an  uncomforta- 
ble state  from  hunger,  fatigue,  or  mental  excitement. 

The  best  tea,  therefore,  is  that  which  is  pleasantest  to  the  taste 
of  the  educated  customer,  and  which  contains  most  of  the  charac- 
teristic sedative  principles.  The  sedative  principles  in  the  leaf 
consist  of  an  essential  oil — which  may  be  smelt  strongest  in  the 
finest  teas,  weakest  in  the  inferior  sorts,  entirely  absent  in  ficti- 
tious teas — and  of  the  alkaloid  them,  which  may  be  demonstrated 
by  heating  some  tea  dry  in  a  silver  pot,  when  the  salt  will  appear 
as  a  white  bloom  on  the  metal.  If  there  is  any  bouquet  at  all,  or 
any  thein  at  all,  in  the  specimen  examined,  it  is  worth  something. 

The  shortest  way  to  test  the  comparative  value  of  different  spec- 
imens is  to  put  a  teaspoonful  of  each  in  one  of  the  little  china  tea- 
pots or  cups  with  covers,  here  used  as  ornaments,  but  originally 
intended  for  this  very  purpose,  which  has  been  previously  made 
quite  hot.  Shake  the  tea  about  in  the  hot  pot  a  few  seconds,  and 
then  pour  on,  quite  boiling,  a  small  half-cup  of  water  on  each. 
Cover  them  up  quickly,  and  let  them  stand  by  the  fire  about  a 

1  Not  less  than  2s.  6^.,  and  not  more  than  10s.  Qd. 

2  I  take  the  opportunity  of  the  first  mention  of  a  purely  foreign  product, 
to  say  that  the  most  interesting  way  of  enlarging  our  ideas  on  the  suhject  of 
food  production,  is  to  spend  an  afternoon  now  and  then  at  a  classified  collec- 
tion of  living  economic  plants,  such,  for  instance,  as  that  at  the  Botanical 
Gardens,  Regent's  Park.     It  is  much  pleasanter  to  think  of  tea  as  connected 
with  the  pretty  little  camelia  it  comes  from,  than  with   blue  paper  packets  ; 
and  the  despised   "grounds"   will  forever  after  acquire  an  interest  in  our 
minds.     Who  would  have  expected  pepper,  and  ginger,  and  rice,  and  sugar 
to  look  as  they  do  when  growing?     No  consumption  of  midnight  oil  over 
botanical  books,  gives  so  much  real  knowledge  as  this  short  hour  of  healthy 
observation. 


54  GENERAL    DIETETICS. 

minute.  Taste  them  immediately  without  milk  or  sugar,  and 
choose  that  which  has  most  aroma. 

On  examination  of  the  contents  of  the  pot  after  use,  there  will 
be  found  in  good  specimens  very  little  of  the  dust  or  broken 
leaves.  The  said  dust,  in  fact,  consists  of  the  sweepings  of  the 
warehouses,  which  the  Chinese  manufacturers  make  up  with  rice- 
starch  into  pellets,  and  use  to  adulterate  the  real  article,  under 
the  name  of  "  Lie  tea,"  -which  expresses  its  character  very  well. 
The  hot  water  dissolves  it  again  into  genuine  dirt. 

As  tea  is  made  from  more  than  one  variety  of  plant  and  from 
leaves  at  different  periods  of  maturity,  the  shape  and  other  char- 
acteristics of  the  foliage  are  not  very  distinctive ;  but  I  think,  as 
a  general  rule,  that,  after  infusion,  the  best  leaves  are  the  thickest 
and  pulpiest  in  texture. 

Green  tea,  normally,  contains  much  more  of  the  essential  oil 
than  black ;  but  then  its  higher  price  offers  a  great  temptation  to 
frauds,  and  if  it  is  used,  more  care  is  needed  in  its  selection. 

Cheap  black  tea  sometimes  owes  its  cheapness  to  the  admixture 
of  leaves  damaged  by  damp,  or  which  have  been  actually  used 
and  redried.  This  is  easily  detected  by  the  scent,  but  as  there 
still  remains  a  quantity  of  tannin  and  coloring  matter,  people  will 
use  it,  and  think  they  have  got  an  article  worth  the  price  it  is 
sold  at.  However,  good  hay,  or  a  bunch  of  wild  thyme  or  mint, 
would  really  afford  a  pleasanter  and  wholesomer  drink.  The 
dried  coloring  matter  is  quite  insoluble,  and  the  tannin  makes  the 
aliment  with  which  it  comes  in  contact  insoluble,  and  indigesti- 
ble also. 

The  chemicals  used  to  put  a  "  face,"  or  agreeable  aspect,  on  bad 
tea  are  not  poisonous,  being  simply  so  much  inert  dirt.  They 
consist  of  indigo,  Prussian  blue,  whitewash,  plaster  of  Paris,  heavy 
spar,  and  the  like ;  new  things  being  substituted  as  the  old  ones 
get  found  out.  Their  presence,  however,  shows  that  the  tea  is 
more  or  less  bad,  or  it  would  not  have  been  faced. 

The  finest  teas  color  the  water  the  least.  The  finest  of  all,  in 
Europe,  the  yellow  tea  which  comes  overland  through  Russia, 
obtainable  at  Frankfort,  and  well  worth  obtaining,  communicates 
only  a  slight  tinge  to  the  infusion.  These  luxuries  are  best  en- 
joyed with  a  slice  of  lemon  in  lieu  of  milk  and  very  little  sugar. 

In  using  tea,  it  must  be  remembered  that  the  small-leaved  and 


ON    THE    CHOICE    OF    FOOD.  55 

fine-grained  tea  packs  much  closer  than  the  coarse,  that  conse- 
quently nearly  double  the  quantity  may  be  contained  in  a  spoon- 
ful, and  therefore  fewer  spoonfuls  are  required. 

Coffee  contains  more  of  its  special  exhilarating  alkaloid  (Caffein) 
than  tea,  but  somewhat  less  essential  oil.  It  should  not  be  kept 
at  the  boiling-point,  or  it  loses  this  virtue. 

The  Purest  way  to  have  genuine  coffee  is  to  purchase  it  in  the 
bean,  with  the  aromatic  scent  (which  shows  that  it  has  been  re- 
cently roasted)  still  in  it,  and  grind  it  yourself.  It  is  easy  to  add 
chicory  if  you  think  it  improves  the  flavor,  but  as  that  root  con- 
tains no  alkaloid,  the  beverage  is  weaker  in  quality.  This  is  de- 
sirable under  certain  circumstances,  to  be  discussed  in  the  second 
and  third  part  of  the  volume.  A  further  security  is  to  buy  the 
beans  raw,  and  roast  them  at  home  over  charcoal ;  the  trouble  is 
repaid  by  the  delicious  incense,  which  alone,  among  the  opera- 
tions of  cookery,  it  diffuses  through  the  house. 

If  you  have  an  opportunity  of  getting  it  direct  from  the  im- 
porter, you  will  find  the  best  coffee  is  that  from  Guatemala.  It 
is  probably  re-christened  "  Mocha  "  in  the  shops.  The  smallest 
and  roundest  beans  are  the  best.  The  long  oval  bean  from  the 
West  Indies  ought  to  be  a  good  deal  cheaper. 

Cocoa  and  Chocolate, — "  Cocoa  nibs  "  is  the  most  eligible  form 
in  which  the  plant  can  be  used  as  a  mere  beverage,  like  tea  or 
coffee.  They  are  the  seeds  merely  broken  up  by  rough  grinding. 
But  much  of  the  nutriment  is  wasted  in  the  thick  grounds ;  so 
that  if  what  is  wanted  is  a  supporting  food,  either  these  must  be 
well  stirred  up  in  the  draught,  or  the  extract  of  the  seeds,  "choc- 
olate," must  be  used.  This  contains  a  large  quantity  of  fatty 
matter  and  may  be  made  a  meal  of. 

Chocolate  is  an  article  so  disguised  in  the  manufacture  that  it  is 
impossible  to  tell  its  purity  or  value.  Indeed,  the  makers  say  it 
is  improved  by  adulteration,  and  cannot  be  sold  without.  The 
only  safeguard  is  to  buy  that  which  bears  the  name  of  a  reputable 
maker. 

Sugar. — The  baser  sort,  "moist  brown,"  always  contains  dirt, 
sand,  and  mites.  If  it  is  dissolved  in  warm  water,  the  heavy 
dirt  falls  to  the  bottom,  and  the  mites  float  on  the  surface,  afford- 
ing an  interesting  object  for  the  microscope.  Grocers  get  from 
handling  it  psoriasis  palmarum  or  "  grocer's  itch,"  so  it  can  hardly 


56  GENERAL    DIETETICS. 

be  a  desirable  condiment  to  eat  raw.  Besides  this,  a  clerical 
friend  of  mine  was  informed  by  a  large  and  religious  grocer  in  a 
manufacturing  town,  that  he  found  it  impossible  to  compete  in 
price  with  his  rivals,  without  adulterating  intentionally  the  whole 
of  his  brown  sugar.  And  he  stated  (not  under  the  seal  of  confes- 
sion) that  one  of  the  materials  used  for  coloring,  was  a  mineral  of 
a  deleterious  nature,  but  he  declined  to  name  it,  as,  seemingly,  in 
this  instance,  cunning  has  advanced  ahead  of  detection. 

The  obvious  moral  is  always  to  use  loaf  sugar  or  sugar  candy, 
the  sophistication  of  which  does  not  answer. 

Treacle. — Common  treacle  is  the  waste  which  drains  off  from 
the  moulds  in  which  refined  sugar  is  made.  It  contains  a  con- 
siderable quantity  of  dirt,  acids,  extractive  matter  of  doubtful 
quality,  and  salts,  so  that  it  sometimes  acts  as  a  purgative. 
"  Golden  drop  "  is  prepared  by  filtering  this  stuff  through  char- 
coal ;  it  should  be  clear  and  light  in  color,  and  is  then  a  whole- 
some article. 

Grape  sugar  is  used  in  England  only  to  adulterate  that  from 
the  cane;  its  sale  might  with  propriety  be  prohibited.  But,  in 
Portugal,  grape-juice  is  boiled  down  with  quinces  into  a  sort  of 
jam,  the  etymological  ancestors  of  all  the  marmalades — whose 
name  is  derived  from  "  marmelo"  the  Portuguese  for  a  quince. 
Let  not  the  reader  be  beguiled  by  a  poetical  regard  for  grapes  or 
quinces  into  eating  it.  My  specimen  was  a  present  direct  from  a 
country  estate  in  the  south,  and  tasted  like  gritty  molasses  and 
onions. .  The  giver  informed  me  it  was  very  wholesome,  but  used 
only  by  servants  and  farm-laborers. 

Raisins,  Sultanas,  Currants,  Figs,  and  Dates,  are  the  dried  fruits 
preserved  by  their  own  uncrystallizable  sugar.  The  muscatel 
raisins  are  the  best,  and  are  prepared  by  allowing  the  grape  to  dry 
on  the  vine ;  the  inference  from  which  is  that  expedients  used  to 
hasten  the  process  are  inexpedient.  The  best  evidence  of  the 
goodness  of  these  articles  is  their  plumpness  and  softness,  com- 
bined with  the  absence  of  mites,  as  tested  by  infusion  in  water,  in 
the  mode  recommended  for  brown  sugar.  Mites  are  not  known 
to  be  poisonous,  but  they  destroy  the  saccharine  constituents,  leav- 
ing only  feculent  remains  and  exuviae,  and  converting  the  remain- 
der into  carbonic  acid.  Now,  it  is  for  their  saccharine  constituents 
that  we  employ  these  dried  fruits,  both  cooked  and  uncooked.  It 


ON    THE    CHOICE    OF    FOOD.  57 

may  be  remarked,  also,  that  the  skins  are  very  insoluble,  those  of 
all  sorts  of  the  grape  containing  a  large  quantity  of  white  wax, 
which  in  fact  waterproofs  the  texture,  and  prevents  its  penetra- 
tion by  aqueous  fluid.  So  they  should  always  be  split  before 
using  in  the  kitchen.  Cakes  made  of  unsplit  currants  are  espe- 
cially to  be  avoided,  as  they  are  apt  to  produce  pain  and  purga- 
tive effects  in  the  most  healthy. 

Rice  should  be  as  whole  and  unbroken,  and  as  free  from  dust 
and  dirt  as  possible.  The  presence  of  weevils  in  it,  constitutes  a 
decidedly  damaged  article,  which  ought  to  be  returned.  In  the 
future  pages,  when  rice  is  spoken  of  in  connection  with  puddings, 
the  Carolina  is  intended ;  for  curries,  or  as  a  vegetable  with  meat, 
the  Patna  is  used,  since  it  best  retains  its  form  when  steamed. 
Patna  rice  is  also  the  most  eligible  thing  to  eat  with  jam,  or  rhu- 
barb, or  roast  apples,  etc.,  for  it  has  the  least  laxative  action  of  all 
cereals,  and  thus  counteracts  the  inconvenient  tendency  in  that 
direction  of  the  sweet  parts  of  the  dish. 

The  preparations  of  wheat  ordinarily  sold  by  grocers,  such  as 
Semolina,  made  from  hard  wheat  rich  in  gluten,  Macaroni,  Italian 
paste,  Vermicelli,  made  of  flour  from  which  the  starch  has  been 
partially  removed,  are  more  nutritious  than  the  flours  of  the  corn- 
dealers  ;  but,  at  the  same  time,  are  less  digestible  from  their  being 
dried  up  so  hard.  They  are  not  suitable  to  be  used  as  vegetable 
dishes,  for  they  are  too  nitrogenous  for  the  purpose.  But,  if  they 
are  long  boiled  till  quite  soft,  they  form  a  substantial  meal.  The 
worst  sort  of  macaroni  is  that  stamped  in  the  form  of  letters,  for 
if  it  be  sufficiently  boiled,  the  shape  of  the  letters  is  lost,  and  cooks 
do  not  like  that. 

These  preparations  are  apt  to  get  "weevilly,"  a  state  of  things 
usually  to  be  detected  by  the  smell. 

Vinegar. — The  best  vinegar  is  that  made  from  the  acidified 
white  wines  of  the  Loire  and  Charente.  British  malt  vinegar  is 
deficient  in  the  oenanthic  ether  which  gives  a  bouquet  to  the  more 
elegant  article,  is  more  apt  to  become  mouldy  and  to  breed  worms, 
and  is  more  often  adulterated.  As  to  distilled  wood  vinegar,  al- 
though its  fundamental  composition  is  identical  with  that  of  wine 
vinegar,  yet  it  has  not  such  a  pleasant  taste  or  smell  as  the  latter, 
for  the  destructive  distillation  of  the  wood  gives  rise  to  some  em- 


58  GENERAL    DIETETICS. 

pyreumatic  products  of  doubtful  wholesomeness,  of  which  traces 
always  are  to  be  found  in  the  product. 

There  seems  nothing  gained  by  scenting  and  flavoring  vinegars. 
It  prevents  their  being  analyzed,  and  thus  excites,  perhaps,  un- 
merited suspicion.  They  smell  like  lotion,  which  is  unpleasant 
at  dinner. 

Vinegar  owes  its  acidity  to  the  acetic  acid,  which  constitutes 
about  a  twentieth  of  its  weight  in  French  vinegar  of  good  quality, 
and  in  British  "  proof"  vinegar  4.6  per  cent,  of  anhydrous  acid. 
As  to  other  substances  contained  in  the  solution,  tartrate  and  sul- 
phate of  potash,  tannin,  and  cenanthic  ether  appear  to  improve  the 
flavor  without  in  any  way  affecting  the  health  of  the  consumer. 
But  it  is  not  so  with  sulphuric  acid,  with -which  bad  vinegar  is 
adulterated.  Sulphuric  acid — especially  if  cheap,  impure  oil  of 
vitriol  be  employed — cannot  be  considered  harmless  if  used  in  the 
daily  food,  in  the  preparation  of  cabbage,  or  pickles,  or  salad,  or 
made-dishes.  The  more  it  is  cooked,  the  more  concentrated  it 
becomes,  for  the  acetic  acid  is  driven  off  by  the  heat,  while  the 
mineral  remains.  The  least  injury  it  can  do  is  to  corrode  the 
teeth,  when  present  in  excess. 

To  avoid  sulphuric  acid  entirely  is,  however,  not  possible,  un- 
less you  make  your  own  vinegar;  and  this  is  really  worth  the 
trouble  if  your  consumption  is  large.  For  the  law  allows  the 
manufacturer  to  introduce  sulphuric  acid  to  the  extent  of  one  part 
in  a  thousand  (in  France  one  gramme  to  one  litre),  and  the  article 
cannot  be  called  adulterated  if  this  amount  is  not  exceeded.  The 
test  recommended  by  the  College  of  Physicians  for  insuring  the 
goodness  of  British  vinegar  used  in  the  preparation  of  medicine  is 
a  solution  of  1  part  of  chloride  of  barium  in  8  parts  of  water:  of 
this  10  minims  will  precipitate  all  the  sulphuric  acid  in  an  ounce 
of  lawful  vinegar.  If,  after  this  has  settled  down,  the  test  solu- 
tion still  continues  to  form  a  cloud,  the  article  should  not  be  em- 
ployed in  the  preparation  of  food. 

Besides  sulphuric  acid,  cheap  dirty  vinegar  sometimes  contains 
lead  and  other  metals.  There  was  an  epidemic  of  lead  poisoning 
some  years  ago  among  the  apprentices  of  a  silk-mill  at  St.  Albans, 
induced  by  pickled  pork.  This  contamination  is  provided  against 
in  the  Pharmacopoeia,  by  ordering  the  test  of  sulphuretted  hydro- 
gen to  be  used. 


ON    THE    CHOICE    OF    FOOD.  59 

Is  it  worth  while  to  test  or  get  tested  such  a  mere  condiment  as 
vinegar?  I  think  so,  for  it  is  really  a  most  useful  adjunct  to  the 
dietary.  It  possesses  the  property  of  softening  and  finally  dissolv- 
ing muscular  fibre,  as  you  may  see  by  watching  its  action  on  a 
fragment  under  the  microscope ;  and,  in  virtue  of  this  solvent  ac- 
tion, it  is  wisely  taken  with  those  meats  whose  fibres  are  hard, 
and  from  their  hardness  insipid,  such  for  example  as  boiled  beef, 
fresh  pork,  brawn,  salmon,  tunny,  sturgeon,  eels,  lobsters,  etc. 
The  resolution  also  of  the  albumen  in  hard-boiled  eggs  is  assisted 
by  vinegar.  Acids  favor  the  conversion  of  cellulose  into  sugar, 
which  is  the  first  stage  of  the  digestion  of  the  materials  for  salad 
— of  cabbages,  and  other  green  leaves — and  their  employment  in 
this  class  of  dishes  is  strictly  physiological.  On  the  other  hand, 
to  put  vinegar  on  beans  is,  in  the  strong  language  of  Monsieur 
Cyr,  "detestable;"1  for  it  renders  insoluble  the  legumin,  which  is 
the  most  nutritious  part  of  them,  constituting,  in  fact,  from  a 
quarter  to  a  third  of  their  substance.2  Cold  boiled  beans  are 
sometimes  made  into  a  salad,  and  it  is  quite  true,  as  M.  Cyr  says, 
that  the  addition  of  vinegar  destroys  the  flavor,  and,  probably 
enough,  makes  it  indigestible.  Oil,  pepper,  mustard  and  a  little 
white  wine,  make  the  best  dressing.  Beans  are  a  favorite  food  for 
persons  practicing  disciplinary  abstinence,  and  the  hint  may  be  of 
use  to  them,  though  not  appreciated  by  the  unrestricted  world. 

OIL — M.  Cyr  places  olive  oil  as  the  highest  in  order  of  digesti- 
bility of  all  fatty  foods,3  even  above  fresh  butter.  But  to  merit  that 
praise  it  must  be  thoroughly  good,  quite  clear  and  transparent 
and  free  from  rancid  smell.  The  paler  it  is,  the  better.  The 
white  deposit  sometimes  seen  is  vegetable  albumen,  which  ought 
to  have  been  refined  out,  as  it  prevents  the  oil  from  keeping  sweet. 
Lucca  oil,  which  is  the  best,  has  a  peculiar,  agreeable  odor,  tech- 
nically called  "  nutty."  Olives  gathered  young  and  small  are 
called  "  French  olives,"  and  in  this  condition  are  the  sort  most 
adapted,  by  their  pleasant  piquancy,  for  eating  as  a  relish.  But 
to  use  in  cookery  they  are  indigestible  and  tasteless,  and  inferior 
to  the  fruit  gathered  at  a  later  period  of  growth,  when  soft  and 

1  Cyr,  Trait6  de  1'Alimentation,  p.  143. 

2  In  horse-beans  30.8  per  cent.,  in  Windsor  beans  29.05  per  cent.,  in  hari- 
cots blancs  25.5  per  cent. — Payen. 

3  Traite  de  1'Alimentation,  p.  122. 


60  GENERAL    DIETETICS. 

pulpy  with  incipient  oiliness,  and  called  "Spanish olives."  These 
last,  also,  are  best  for  salads.  In  Portugal,  they  refuse  to  gather 
them  till  they  are  just  beginning  to  turn  purple,  and  then  they 
are  bitter  and  not  so  digestible ;  but  I  am  informed  by  a  Portu- 
guese country  gentlemen  that  they  might  be  just  as  good  as  the 
highest  priced  French  fruit,  if  the  farmers  would  be  persuaded  to 
advance  upon  the  traditions  of  their  grandfathers.1 

Caviare  should  be  soft,  pale  in  color,  and  exhibiting  the  ova  of 
the  roe  quite  distinct.  When  old  and  black,  and  homogeneous 
in  texture,  it  is  out  of  season  and  rancid,  and  arrests  digestion. 
It  is  wise  never  to  eat  it  when  you  see  it  served  carelessly  with 
cold,  withy  toast.  It  should  be  sent  up  in  a  toasted-cheese  dish. 

Pickles. — Grocers  appear  to  consider  that  the  final  use  of  pickles 
is  to  ornament  shops :  so  they  choose  them  for  the  brilliancy  of 
their  colors  and  the  elegance  of  the  arrangement  of  their  contrasted 
forms  in  the  bottle.  The  consequence  is  that  all  sorts  of  expedi- 
ents, some  of  them  highly  deleterious,  are  used  by  manufacturers 
to  enhance  "the  fatal  gift  of  beauty."  In  twelve  samples  of 
pickles  taken  indiscriminately  and  examined  in  behalf  of  the 
State  Board  of  Health  of  Massachusetts  by  Mr.  Hill,  last  year, 
ten  were  found  to  contain  copper,  by  the  simple  process  of  dipping 
in  them  a  steel  knitting-needle,  which  in  a  few  hours  became 
coated  with  the  metal.  Nine  of  the  samples  were  also  examined 
for  alumina  and  found  to  contain  it,  showing  that  alum  had  been 
used,  probably  to  intensify  the  lake  tints.  (Fourth  Annual  Re- 
port, Boston,  1873.) 

Black  pepper  in  powder  is  another  article  which  the  conscien- 

1  I  take  this  opportunity  of  alluding  to  the  trade  custom  of  designating 
peculiar  qualities  or  kinds  of  food  by  local  names.  No  fraud  is  intended,  and 
any  legislation  which  would  make  the  transaction  a  fraud,  would  be  unjust. 
The  words  "Spanish  "  and  "  French  "  do  not  mean  that  the  olives  come  from 
Spain  or  France,  but  that  they  are  of  the  sort  made  in  those  countries.  A 
large  quantity  of  "  Ostend  rabbits"  used  to  come  to  the  London  market  from 
near  Marseilles,  but  an  importer  told  me  they  were  bred,  fed,  killed  and 
skinned  like  "Ostend  rabbits,"  and  therefore  to  all  intents  and  purposes 
"  Ostend  rabbits."  So  a  wine  merchant  that  sells  his  prime  claret  as  "Cha- 
teau Margaux,"  is  committing  no  fraud,  if  his  wine  is  as  good  as  Chateau 
Margaux,  though  it  might  be  proved  to  have  never  seen  that  famous  property. 
Furriers  are  in  the  habit  of  calling  tabby-cats'  skins  "Japanese  lynx,"  and 
the  best  "plover's  eggs"  are  usually  laid  by  gulls  on  the  East  coast:  in 
neither  case  is  there  any  intention  to  deceive. 


ON    THE    CHOICE    OF    FOOD.  61 

tious  grocer,  lately  mentioned,  declared  he  could  not  sell  at  a  profit 
without  increasing  its  bulk  by  artificial  means.  It  does  not,  how- 
ever, appear  that  any  of  the  dirt  introduced  is,  to  the  knowledge 
of  the  adulterators,  deleterious  to  health.  The  simple  safeguard  is 
to  buy  the  pepper  in  corn. 

Red  pepper  when  pure  is  entirely  suspended  when  rubbed  in 
warm  water.  If  a  red  deposit  falls,  it  is  generally  red  lead,  a  nox- 
ious metal. 

Mustard  is  usually  adulterated  by  the  grinders  with  flour  and 
turmeric,  which  are  not  injurious  to  health,  so  that  the  verifica- 
tion of  the  drug  becomes  a  question  for  the  economist,  not  for  the 
dietician. 

Spices,  in  general,  should  not  be  purchased  ground.  And  it  is 
a  prudent  proceeding  for  members  of  our  profession  to  take  the 
opportunity  offered  them  by  the  liberality  of  the  Society  of  Apoth- 
ecaries, and  lay  in,  at  the  wholesale  market  price,  a  stock  of  the 
purest  and  best  spices.  They  have,  thus,  test  articles  which  they 
can  compare  with  those  furnished  in  "  our  village."  It  will  some- 
times be  found  that  the  latter,  even  with  the  grocer's  profit  on 
them,  are  the  cheapest;  and  then  of  course  they  must  be  adulter- 
ated or  damaged  goods. 

Bacon  and  Ham,  when  properly  prepared  and  not  rusty,  give 
us  a  fat  much  more  digestible  and  therefore  more  nutritious  than 
that  of  fresh  pork.  The  process  of  salting,  and  still  more  that  of 
slowly  drying  or  smoking,  removes  a  great  quantity  of  the  water, 
and  coagulates  the  serum,  which  tend  to  make  the  adipose  matter 
readily  run  into  rancidity.  What  we  have  to  do  in  selection  is  to 
see  that  the  removal  of  water  is  carried  as  far  as  possible,  and  this 
is  accomplished  by  observing  the  loss  of  weight  in  cooking. 
Primest  bacon,  according  to  Dr.  Letheby,  should  not  lose  much 
above  a  tenth  in  boiling;  and  ham  wastes  much  less. 

Sausages. — After  the  sensational  descriptions  of  their  manufac- 
ture, sent  to  journals  by  special  correspondents,  it  may  be  pre- 
sumed no  one  eats  sausages,  without  some  acquaintance  with  the 
person  who  has  prepared  them.  There  is,  or  was,  in  Oxford 
a  large  open  window  through  which  one  could  see  a  stalwart 
maiden,  with  her  arms  glowing  from  frequent  immersion  i<i  cold 
water,  chopping  and  stuffing  these  savory  viands ;  and  1  have  a 
lively  recollection  of  the  pleasure  with  which  I  welcomed  them 


62  GENERAL    DIETETICS. 

afterwards  on  the  breakfast  table.  I  have  often  thought  since  of 
the  scene,  when  hearing  the  chopping  machine  going,  in  cellars 
and  back  premises  in  London,  and  have  wondered  that  some 
honest  maker  has  not  taken  the  course  of  giving  confidence  by 
publicity. 

"  German  "  sausages  are  of  unknown  composition. 

§  7.  DAIRY  PRODUCE. 

Milk. — To  people  who  do  not  keep  their  own  cows,  the  purchase 
of  milk  is  a  matter  of  extreme  importance,  so  much  of  it  is  used 
in  every  well-managed  family,  and  so  sensitive  to  noxious  influ- 
ences are  the  junior  branches,  which  are  its  assiduous  consumers. 
But  it  must  be  confessed  that  to  the  exclusion  of  the  noxious  in- 
fluences liable  to  be  conveyed  in  milk,  science  affords  very  little 
help.  There  are  machines  for  taking  the  specific  gravity,  of 
which  the  most  convenient  is  the  hydrometer  sold  by  surgical  in- 
strument-makers as  a  urinometer.  And  there  are  machines  for 
measuring  the  quantity  of  cream,  of  which  that  generally  used  is 
the  lactometer,  devised  by  Sir  Joseph  Banks,  a  tall  test-tube  in 
which  the  cream  rises  to  the  top,  and  is  simply  measured.1  And 
for  more  accurate  estimation  we  have  Vogel's  Galactoscope,  in 
which  instrument  the  quantity  of  cream  is  calculated  by  the  de- 
gree of  opacity  caused  by  the  thickness  of  a  layer  of  milk  neces- 
sary to  obscure  the  light  of  a  candle.  By  this,  we  may  guess 
whether  our  milkman  has  put  much  or  little  water  into  the  can, 
whether  he  has  intentionally  cheated  us  by  selling  the  produce  of 
the  pump  as  that  of  the  dairy;  but  that  has  not  much,  if  any  in- 
fluence on  the  appropriateness  of  the  milk  for  food.  If  less 
strongly  nutritious,  diluted  milk  is  quite  as  wholesome  as  undi- 
luted, and  more  easily  digestible.  The  cases  which  call  for  the 
use  of  such  measures  of  commercial  value  are  those  of  public  in- 
stitutions, such  as  hospitals,  prisons,  workhouses,  where  it  is  our 
business  to  make  sure  that  the  poor  persons  towards  whom  we 
occupy  a  paternal  position  are  not  defrauded  of  the  limited  nutri- 
ment supplied  to  them.  If  the  milk  comes  from  starved  animals 
or  from  the  pump,  they  ought  to  have  more  of  it  in  just  pi'oportion. 

1  Is  it  too  late  to  revise  the  barbarous  title  of  this  instrument,  and  call  it 
(say)  the  "  Cream-reckoner  ?" 


ON    THE    CHOICE    OF    FOOD.  63 

The  real  poisons  whose  possible  presence  throws  a  dark  shadow 
over  the  enjoyment  of  this  delicious  drink,  are  quite  independent 
of  its  richness  or  the  reverse.  They  are  those  arising  from  an  un- 
healthy condition  in  the  cow,  or  in  the  human  dwellers  in  the 
dairy,  or  from  gross  carelessness  in  keeping  its  produce.  After 
calving,  the  udder  yields  a  thickish  yellow  fluid,  somewhat 
stringy  and  greasier  than  ordinary  milk,  slightly  reddening  lit- 
mus-paper. 

Till  this  has  ceased  to  be  secreted,  whether  the  period  is  a  day 
or  two,  or  as  many  weeks,  the  milk  has  a  purgative  action  when 
raw,  and  even  when  boiled  and  made .  into  a  pudding,  as  is  the 
custom  of  some  parts,  is  of  doubtful  wholesomeness.  An  admix- 
ture of  it  in  the  dairy  produce  may  be  detected  by  skilful  micro- 
scopic examination,  which  shows  the  presence  of  colostrum  cor- 
puscles. The  best  way  to  exhibit  them  is  to  mix  some  water  with 
the  colostrum,  let  it  stand  a  few  days  till  the  cream  has  risen  en- 
tirely, and  then  collect  the  sediment  from  the  bottom  of  the  test- 
tube,  which  will  be  found  to  consist  entirely  of  them.  Their 
measurement,  according  to  Aland],  is  about  -$^w  of  an  inch  in 
diameter.1  Colostrum  is  apt  to  coagulate  the  milk  like  rennet. 

Of  more  serious  importance  is  the  presence  of  inflammatory  or 
febrile  disease  in  the  cow.  It  is  known  by  the  appearance  of 
blood  or  pus  in  the  milk,  but  more  readily  by  the  sickening  odor 
which  exhales  from  it.  If  this  is  accidentally  swallowed  it  disa- 
grees strongly  with  the  stomach,  and  if  the  disease  is  infectious,  it 
may  very  probably  be  communicated  in  this  way. 

A  more  likely  way,  however,  for  disease  to  be  induced  through 
milk,  is  its  contamination  during  its  transit  from  the  cow  to  the 
customer.  Where  inmates  of  the  farm  have  been  affected  by  ty- 
phoid fever,  the  infection  has  been  carried  to  the  families  in  the 
distant  town  supplied  from  that  quarter.  It  is  just  possible  that 
the  germs  of  the  malady  may  have  settled  in  the  milk  from  the 
air;  but  a  more  probable  supposition  is  that  the  subsoil  water,  and 
so  the  wells,  had  become  contaminated  with  the  morbid  secretions, 
and  had  been  used  in  washing  the  milker's  hands,  the  pails,  and 
pans  of  the  dairy.  In  a  recent  notorious  case,  occurring  in  Lon- 
don in  1873,  this  seems  to  have  been  fairly  proved  to  be  the  path 
of  the  invasion  of  typhoid;  but  it  would  not  have  been  proved 

1  Dr.  J.  L>iivy  in  Med   Chir.  Transactions,  xxviii,  82. 


64  GENERAL    DIETETICS. 

had  not  Dr.  Murchison  taken  up  the  investigation  with  extraordi- 
nary energy  and  perseverance.  This  danger  is  unhappily  not 
capable  of  being  warded  off  by  science.  The  fatal  substance 
which  brings  typhoid  fever  into  our  bodies  cannot  be  distinguished 
from  other  organic  matters,  nor  can  its  existence  be  made  evident 
by  any  chemical  or  microscopic  observation.  By  its  works  alone, 
and  too  late,  do  we  know  it.  The  only  possible  protection  lies  in 
the  scrupulous  observation  of  dairy  farms  by  sanitary  inspectors, 
to  report  on  any  communication  between  the  drains  and  wells,  and 
instantly  to  warn  the  customers,  if  the  farmers  refuse,  to  stop  the 
sale  of  dangerous  milk  as  human  food.  It  would  be  a  good  plan 
for  the  customers  of  any  one  establishment  to  appoint  their  own 
inspector. 

The  evidence  of  the  transmission  of  scarlatina  by  milk,  is  not 
so  conclusive  as  in  the  case  of  typhoid. 

There  are  no  other  impurities  injurious  to  health  known  to 
exist  in  the  milk  of  our  shops :  caramel,  brown  sugar,  salt,  and 
carbonate  of  soda  have  been  detected,1  but  not  the  chalk,  starch, 
brains,  or  other  substances  sometimes  asserted  to  be  employed  as 
adulterants. 

Milk  is  sometimes  rendered  unwholesome  in  the  customer's 
own  house,  by  the  vessels  in  which  it  is  received  not  having  been 
properly  scoured  out  with  soda.  On  stale  milk,  even  in  minute 
quantities,  there  very  quickly  germinates  a  blue  mould,  such  as  is 
seen  often  on  cream  cheese,  and  called  Didium  lactis.  The  mix- 
ture of  this,  adhering  to  the  corners  of  the  can,  with  the  fresh 
milk,  causes  it  to  turn  sour,  and  to  give  rise  to  colic  and  diarrhoea, 
and,  it  is  not  unlikely,  also  to  "  thrush  "  in  children,  for  the  crust 
which  forms  in  the  mouth  is  not  a  dissimilar  form  of  mould. 

The  purity  of  the  milk  supply  is  a  matter  of  extreme  import- 
ance, and  fitly  forms  the  subject  of  legislative  interference,  pro- 
vided always  that  the  legislative  interference  be  judicious  and 
does  not  impede  improvement  by  competition.2  It  is  a  subject  of 

1  Fourth  Annual  Keport  of  the  State  Board  of  Health,  Massachusetts, 
1873,  p.  295.' 

2  Of  such  injudicious  sort  would  be,  for  example,  the  fixing  an  absolute 
standard  of  crea.m  contents.     The  standard  must  be  low,  or  much  genuine 
milk  would  be  condemned  ;  and  then  when  any  dealer  got  milk  richer  than 
the  standard,  he  would  water  it  down  to  the  mark,  and  thus  the  pump  would 
be  more  active  than  ever. 


ON    THE    CHOICE    OF    FOOD.  65 

pre-eminent  importance  to  the  healthy,  above  all  others.  I  al- 
ways feel  indignant  when  I  see  advertised  special  milk,  in  sealed 
cans  or  otherwise,  for  the  nursery  or  for  invalids.  As  if  the 
health  of  the  sick  and  weakly  were  more  important  than  that  of 
the  strong  man,  on  whose  arm  those  sick  and  weakly  depend  for 
existence.  Let  us  keep  our  strong  men  well,  and  we  shall  have 
fewer  invalids  to  attend  to.  In  choosing  between  two  shops,  I 
should  always  prefer  the  one  that  did  not  advertise  a  special 
article. 

Cream,  when  good,  is  thick,  clouty  and  yellow. 

BuiteriiiUk  -is  one  of  the  most  wholesome  summer  drinks  possi- 
ble. It  is  equally  refreshing  and  nutritious,  and  to  see  it  given 
to  pigs  instead  of  being  distributed  to  the  neighbors  makes  the 
philanthropist's  heart  bleed. 

Whey  from  which  the  curd  has  been  removed  for  the  purpose 
of  making  cheese,  is  apt  to  be  somewhat  sour,  from  the  rennet  by 
which  coagulation  has  been  effected.  But  even  then  it  is  a  pleas- 
ant summer  drink,  and  is  certainly  very  digestible,  and  rapidly 
absorbed,  for  it  is  in  composition  more  like  serum  sanguinis  than 
anything  else.  A  grate  of  nutmeg  makes  it  very  palatable.  In 
Switzerland  it  is  often  drunk  as  a  diet  drink,  and  the  inhabitants 
have  such  a  high  opinion  of  its  wholesomeness,  that  they  have 
founded  establishments  for  the  special  purpose  of  receiving  pa- 
tients for  the  cure  of  all  sorts  of  diseases  by  its  means.  This 
"  Molken-Kur,"  as  it  is  called,  does  not  however  seem  to  suit 
English  constitutions,  unless  starvation  is  required  to  be  the  prin- 
ciple of  treatment,  as  is  rarely  the  case. 

Junkets  and  Curds  are  nutritious  nitrogenous  foods,  but  they 
require  the  stomach  to  be  educated  by  use  for  them  to  be  well 
borne  in  any  valid  quantity.  Milton's  mention  of"  the  junkets" 
seems  to  imply  that  they  were  formerly  more  of  an  ordinary  diet 
in  farm-houses  than  now. 

Condensed  or  "  Siviss"  milk  is  a  device  for  avoiding  the  risk  of 
deterioration  by  shaking.  Six-tenths  of  the  water  is  dried  out  of 
it,  and  sugar  is  added  as  a  preservative.  It  certainly  is  digestible, 
as  is  shown  by  the  fact  of  infants  brought  up  by  hand  upon  it 
growing  fat,  and  apparently  strong,  a  fact  of  which  most  of  us 
have  ocular  proof.  Great  care  should  be  taken  that  only  the 

5 


66  GENERAL    DIETETICS. 

softest  water  is  used  for  its  solution,  and  precautions  taken  against 
its  adulteration.  As  it  is  a  recent  invention  it  is  pure  enough  at 
present,  but  extensive  use  will  probably  teach  ingenious  methods 
of  sophistication. 

Clotted  cream  is  simply  cream  skimmed  from  heated  milk. 
Great  accuracy  is  necessary  to  secure  the  right  temperature,  yet 
the  union  of  the  offices  of  cook  and  dairymaid  which  it  entails 
does  not  insure  accuracy.  If  the  mistress  of  the  household  will 
make  it  a  few  times  with  her  own  hands,  she  will  find  no  difficulty 
in  producing  a  digestible  article  by  observing  the  following  pre- 
cautions, and  for  very  shame  her  example  will  be  imitated. 

Clotted  cream  is  simply  cream  raised  by  heat,  so  that  a  little 
albumen  is  partially  coagulated  along  with  it.  Take  a  well- 
scoured  stout  saucepan  (a  broad  copper  one  is  best)  and  put  a  tea- 
cupful  of  quite  cold  water  in  it,  then  pour  in  the  whole  milk  and 
heat  it  over  a  very  slow  fire  (charcoal  is  best)  till  the  cream  rises ; 
when  it  does  so,  take  care  not  to  increase  the  heat,  but  keep  it  up. 
It  should  never  exceed  that  which  the  finger  can  easily  bear 
(about  150°).  As  the  clot  rises,  divide  it  down  the  middle  with 
the  finger,  and  turn  it  back  on  itself.  Keep  doing  this  till  there 
is  no  more  formed.  A  bain-marie  and  a  thermometer  are  a  re- 
finement upon  tins  method. 

Bought  clotted  cream  is  apt  to  make  the  delicacy  unpopular. 
It  is  often  sour,  and  adulterated  with  sugar  and  flour. 

Butter,  like  milk,  is  adulterated  with  an  excess  of  water,  which 
may  be  detected  by  boiling ;  the  oily  matter  floats,  and  the  water 
underlies  it.  But  neither  in  that,  nor  in  any  other  detected  falsi- 
fication is  there  any  source  of  danger  to  health.  Even  when 
rancid  and  damaged  butter  is  got  up  again  in  order  for  the  market, 
the  processes  are  such  as  to  make  it  fit  for  food,  though  not  so 
nice  as  when  naturally  sweet.  The  palate  is  a  good  guide ;  but 
sometimes  in  autumn  and  winter,  when  the  grass  is  scanty,  the 
butter  will  be  flavored  with  the  dead  leaves  or  turnips  Avhich 
stingy  farmers  will  let  their  cattle  eat,  and  we  must  not  condemn 
the  article  as  unwholesome  because  it  is  nasty  at  these  times. 


ON    THE    CHOICE    OF    FOOD.  67 

Cheese. 

Classification  of  Cheeses  usually  in  the  Market. 

Cream  cheeses,  .    f  Gruelthorpe. 

\  Neucbatel. 
f  Stilton. 
Double  Gloucester. 

Cheeses  made  of  whole  milk  rich  in  cream,  \   , 

Gorgonzola. 

Cheshire. 
Cheddar, 
f  Single  Gloucester. 

Cheeses  made  of  poor  or  partially  skimmed  j   Shropshire, 
milk,          .         .         .         .         .         .         .   I   American. 

[  North  Wiltshire, 
/-  Suffolk. 

Cheeses  made  of  skimmed  milk,  .         .         .  -I   Parmesan. 

(.  Dutch. 

Cheese  is  required  for  two  purposes ;  one  is  for  eating  in  small 
quantities  as  a  fillip  to  the  palate,  and  the  other  is  in  order  that  it 
may  serve  as  a  substantial  food.  For  the  first  purpose  it  may  be 
produced  in  a  rancid,  decayed  state,  and  is  best  when  of  a  rich 
buttery  sort.  But  to  be  taken  as  a  meal,  to  satisfy  hunger,  newer 
cheese  is  better.  Poor  cheeses,  such  as  the  Dutch,  are  wholesome 
and  digestible  if  cut  in  very  thin  slices  and  buttered.  Toasted 
cheese  is  also  digestible  if  it  is  new  and  lightly  cooked  with  cream 
and  butter.  Tough  toasted  cheese  is  about  as  soluble  as  leather. 

Eggs. — To  choose  eggs,  dissolve  one  ounce  of  common  salt  in 
half  a  pint  of  water,  that  is,  ten  fluid  ounces  measured  with  a 
medicine  measure  glass.  In  brine  of  this  strength  a  good  egg  will 
sink,  a  bad  egg  will  float.  If  held  up  to  a  candle  a  fresh  egg  will  be 
found  to  be  more  transparent  than  a  stale  one,  or  than  one  with 
a  chicken  in  it.  Fresh  eggs  are  most  transparent  in  the  centre, 
stales  ones  at  the  end. 

If  absolutely  necessary,  eggs  may  be  preserved  some  time  by 
rubbing  them  well  with  fresh  grease  when  taken  warm  from  the 
hen-house.  But  if  they  acquire  a  smell  of  old  straw  they  are  unfit 
for  food.  Lime  gives  them  a  peculiar  taste,  and  prevents  the 
albumen  setting. 

Rennet. — Rennet  is  not  always  to  be  obtained  good  in  the  coun- 
try. It  may  be  thus  prepared  for  domestic  use  in  making  whey, 
junkets,  etc.  Take  a  calf's  "  bag  "  with  the  curd  in  it  (that  is  the 


68  GENERAL    DIETETICS. 

fourth  stomach,  or  abomasus,1  filled  with  acid  chyle),  pick  out  all 
the  hairs,  and  wash  bag  and  curd  clean.  Then,  replace  the  curd 
in  the  bag  with  six  or  seven  ounces  of  salt,  and  set  them  by  for  a 
week  in  a  cool  dairy.  Then,  take  a  strong  brine,  made  of  a  quart 
of  water  to  a  pound  of  salt,  and  pour  it  cold  on  the  rennet.  When 
it  has  stood  again  for  a  wreek,  the  liquor  is  fit  for  use. 

§  8.  BREAD  STUFFS. 

There  is  no  bread  so  digestible  as  that  made  by  an  honest,  ex- 
perienced baker.  In  baking  at  home  you  secure  the  honesty,  but 
you  lack  the  experience.  The  chance  has  to  be  taken  of  a  bad 
batch  through  some  accident ;  and  then  the  best  must  be  ma^le  of 
it  till  it  is  finished. 

If  one  had  to  live  on  bread  alone,  brown  bread  would  perhaps 
be  preferable,  for  (as  Professor  Liebig  taught  us)  it  contains  in  the 
bran  and  pollards,  which  are  returned  to  it  after  grinding  to  make  it 
brown,  a  considerable  quantity  of  phosphate  of  lime,  valuable  as 
nutriment  to  the  bones  and  other  tissues.  But  the  fact  is,  most  of 
us  take  in  other  ways  plenty  of  phosphates  in  a  more  digestible 
form  than  bran,  and  the  irritating  eifect  which  it  has  on  the  bowels 
shows  that  it  is  not,  in  this  form,  made  much  use  of  by  them 
as  a  nutriment.  White  bread  is  generally  chosen  in  preference  by 
shrewd  working  men  who  wish  to  make  the  money  spent  on  food 
go  as  far  as  it  can.  It  is  also  far  less  likely  to  be  withy  and 
tough,  and  is  less  often  adulterated. 

Not  but  that  some  admixture  of  the  bran  is  pleasant,  both  to 
the  eye  and  to  the  palate,  as  in  the  flour  which  is  called  "  seconds," 
which  makes  a  very  good  bread,  probably  in  consequence  of  this 
flour  not  being  over-ground.  Too  much  friction  ruptures  the 
starch-granules,  and  the  dough  does  not  rise  well. 

Bread  should  be  evenly  porous  without  any  large  holes,  like  a 
fine  sponge.  The  texture  should  be  firm,  of  which  virtue  the  best 
test  is  the  being  able  to  cut  it  up  into  thin  bread  and  butter. 
Tough,  clammy  new  bread  becomes  wadded  together  into  an  in- 
soluble mass  by  chewing,  is  not  penetrated  by  the  saliva  or  gastric 
j  uice,  ferments  anew,  and  even  in  strong  persons  is  apt  to  produce 

1  It  is  figured  in  a  volume  previously  referred  to,  Dalton's  Human  Physi- 
ology, p.  105. 


ON    THE    CHOICE    OF    FOOD.  69 

a  disagreeable  form  of  heartburn.  If  from  necessity  it  must  be 
eaten,  heating  and  copious  buttering,  as  we  heat  rolls  or  crumpets, 
is  the  best  expedient  to  make  it  as  digestible  as  circumstances 
admit. 

A  considerable  portion  of  water  quickly  evaporates  from  hot 
bread,  causing  of  course  a  loss  of  weight,  so  that  bakers  will  some- 
times try  to  prevent  it  by  covering  up  the  loaves  from  the  air.  The 
crust  is  thereby  rendered  withy,  and  the  crumb  is  wet  and  tough, 
besides  which  you  are  buying  water  at  the  price  of  bread. 

There  is  another  and  more  objectionable  way  in  which  the  loaf 
is  forced  to  hold  water  in  excess,  that  is,  the  addition  of  boiled 
rice-flour.  It  is  a  sticky  gummy  paste,  which  renders  the  dough 
more  adhesive,  and  prevents  evaporation.  So  that  21  quartern 
loaves  are  made  with  what  ought  to  make  only  20.  They  may 
be  found  out  by  their  sodden  bottoms,  the  water  gravitating  by 
standing.  To  shirk  this  test,  bakers  will  turn  them  upside  down 
on  the  shelves,  which  always  looks  suspicious. 

I  am  told  by  a  retailer  of  glue  that  bakers  buy  a  good  deal  of 
that  substance,  and  the  inference  is  that  it  is  used  in  the  same  way 
to  make  the  dough  adhesive. 

It  is  said,  also,  that  alum  is  added  for  the  same  fraudulent  pur- 
pose, even  to  good  flour.  But  its  object,  generally,  is  to  make  a 
damaged  article  bear  a  good  white  color,  and  stop  the  excess  of 
fermentation  to  which  it  is  liable.  Alum  is  easily  detected  in  the 
laboratory  by  incinerating  the  bread  suspected  to  contain  it,  and 
our  analysts  are  active  in  this  direction.  However,  they  must 
guard  against  being  too  pedantic,  and  a  distinct  line  must  be 
drawn  between  a  baker  who  habitually  uses  a  great  quantity  of 
adulterant  to  dispose  of  flour  which  he  has  wilfully  bought  in  a 
bad  state,  and  one  who  now  and  then  rectifies  an  accidental  loss 
of  goodness  by  the  employment  of  the  drug.  But  certainly,  the 
less  aluni  he  uses,  the  more  he  is  to  be  trusted. 

The  best  bread  grows  stale  the  slowest.  "Aerated  bread," 
where  the  dough  is  raised  according  to  Dauglish's  patent,  by 
forcing  pure  carbonic  acid  into  it,  keeps  better  than  any.  It  is 
free  from  the  objectionable  presence  of  the  remains  of  the  yeast, 
not  to  be  avoided  otherwise,  and  is  more  certain  to  be  wholesome 
than  ordinary  bread.  It  is  popular,  too,  at  that  test  of  palatable 
simplicity,  the  nursery  tea-table. 


70  GENERAL    DIETETICS. 

Yeast  is  a  great  difficulty  with  those  who  bake  at  home. 
Brewer's  barm  is  the  best,  but  it  is  apt  to  go  dead  between  one 
baking  and  another,  and  is  not  easy  to  be  got.  Country  trades- 
men object  to  sell  it,  but  many  retail  bakers  in  London  will  en- 
gage to  send  regularly  by  post  an  ounce  or  two  of  "German  yeast," 
which  thus  arrives  quite  fresh  and  active.  An  orderly  cook  can 
keep  a  ferment  in  constant  action  by  starting  it  with  some  "  Ger- 
man yeast "  from  the  regular  manufacturers  of  that  article,  and 
feeding  the  mixture,  placed  in  a  cool  situation,  with  some  fresh 
malt  and  mashed  potato  or  dough,  daily. 

An  acquaintance  with  the  theory  of  fermentation  as  explained 
in  all  books  of  physiology,  and  recently  made  doubly  instructive 
by  the  researches  of  M.  Pesteur,  will  enable  an  educated  person 
to  point  out  the  remedy  for  all  difficulties  encountered  in  the 
kitchen.  There  is  no  more  favorable  subject  for  interesting  un- 
lettered minds  in  nature's  wonders.  I  have  seen  a  country  con- 
gregation quite  breathlessly  attentive  to  an  account  from  the  pulpit 
of  the  recent  addition  to  our  knowledge  on  this  head ;  and  I  am 
sure  that  when  their  dough  has  risen  well,  they  have  remembered 
the  moral  impressed  upon  them. 

Biscuits  are  too  hard  for  ordinary  consumption  as  a  bread-stuff, 
if  made  from  flour  and  water  only,  as  "  captains  "  and  "  ship  bis- 
cuits" are.  They  are  very  useful,  however,  to  travellers,  in  rea- 
diness for  those  frequent  occasions  on  which  the  bread  is  tough, 
sour,  bitter,  or  otherwise  uneatable.  They  bear  well  exposure 
and  rough  treatment,  and  if  soaked  for  a  few  hours  in  water  or 

O  / 

milk,  they  take  up  several  times  their  own  weight  of  fluid,  soften 
and  swell,  and  with  a  little  cream  and  sugar  make  a  dainty  dish 
of  eminent  digestibility.  Biscuit  powder  for  infants  should  be 
made  from  this  kind. 

Fancy  biscuits  are  too  numerous  to  describe,  and  of  various 
merits.  The  addition  of  milk,  sugar,  eggs,  flavors,  etc.,  makes 
them  less  digestible  than  the  plainer  sort.  Those  made  on  a  large 
scale  by  special  manufacturers  are  the  best,  because  in  them  the 
partial  raising  of  the  dough  is  effected  by  piain  carbonic  acid,  in- 
stead of  carbonate  of  ammonia. 

When  biscuits  become  damaged,  they  are  often  damped  and 
heated  anew  in  the  oven.  They  quickly  lose  the  artificial  new- 
ness thus  acquired,  and  grow  stale  and  musty.  So  they  are  safest 


ON    THE    CHOICE    OF    FOOD.  71 

purchased  in  tins,  where  they  are  not  so  likely  to  be  tampered 
with, 

Oatmeal. — The  coarsely-ground  Scotch  oatmeal  is  the  most 
suitable  both  for  porridge  and  cakes.  If  imperfectly  boiled,  as 
when  prepared  in  a  hurry,  or  intentionally  unboiled  as  in  ,brose, 
it  is  extremely  indigestible,  and  produces  the  most  obstinate  cases 
of  pyrosis  in  the  parts  of  the  country  where  it  is  habitually  used. 
But  when  well  boiled,  and  eaten  slowly  so  as  to  become  well 
mixed  with  saliva,  it  is  a  most  wholesome  as  well  as  most  nutri- 
tious food.  An  oaten  diet  has  bred  the  Scotch  farmer  and  the 
English  horse,  and  where  will  their  equals  be  found  ? 

Emden  grits  are  the  best  adapted  form  of  oats  for  gruel. 

Barley  and  rye  do  not  appear  to  possess  any  distinctive  virtues 
which  can  give  them  an  interest  in  the  eyes  of  a  medical  man. 
Though  useful  when  other  cereals  are  not  to  be  got,  they  are  in- 
ferior to  them  in  solubility  and  nutritive  power,  and,  at  the,  same 
time,  have  not  the  attractive  taste  which  would  cause  them  to  be 
a  temptation  against  which  a  warning  is  necessary. 

Maize  .in  various  forms  is  often  recommended  as  a  valuable 
food.  It  contains  a  good  deal  of  fattening  matter,  and  on  that  ac- 
count is  used  for  fattening  geese  at  Strasbourg,  and  other  domestic 
animals  elsewhere.  But  its  oleaginous  constituents  incline  it 
readily  to  grow  rancid,  when  it  has  a  fusty  disagreeable  smell. 
When  stale,  therefore,  it  is  apt  to  disagree,  and  in  horses  often 
causes  a  sort  of  eczema  of  the  skin.  To  our  race,  damaged  maize, 
persisted  in  as  a  food,  is  still  more  deleterious,  producing,  for  ex- 
ample, in  Lombardy  and  the  Valtelina,  a  special  endemic  cuta- 
neous disease — Pellagra — which  is  year  by  year  slowly  widening 
its  fatal  shadow  over  the  finest  lands  tilled  by  man.1 

Maize  flour  may  be  refined  and  made  safer  by  washing  out  the 
nutritive  portion  with  alkalies,  and  in  this  state  professes  to  con- 
stitute "  oswego,"  "maizena,"  "corn-flour,"  etc.  But  the  eater 
should  understand  that  he  has  before  him  starch  only,  and  must 

1  The  IVllagra  is  the  punishment  of  sin.  The  farmers,  cultivating  their 
lands  on  the  metayer  system,  the  landlord  and  tenant  dividing  the  crop,  are 
tempted  to  hide  some  of  the  grain  in  holes  and  corners,  where  it  gets  mouldy. 
They  find  it  makes  their  fowls  ill,  so  they  eat  it  themselves.  See  Lombroso. 
Sulla  Pellagra,  where  figures  are  given  of  the  peculiar  mould  to  which  the 
author  attributes  this  very  serious  plague. 


72  GENERAL    DIETETICS. 

not  reckon  on  it  for  nitrogenous  nutriment.  The  economist  will 
probably  think  he  can  buy  starch  cheaper  in  the  form  of  rice  flour, 
which,  indeed,  is  often  sold  under  these  fancy  names,  according  to 
the  evidence  of  Dr.  Bartlet  before  the  Adulteration  Committee 
this  summer. 

Other  forms  of  Starch  commonly  sold. 

Arrowroot  (West  Indian  best). 

Cassava  meal. 

Potato  starch  (uncolored). 

Sago  (unbleached  best). 

Sago  meal. 

Salep. 

Tacca  starch,  or  "  Otaheite  Arrowroot." 

Tapioca. 

Tapioca  meal,  or  "  Brazilian  Arrowroot." 

Tous-les-mois  (West  Indian). 

The  only  preference  that  can  be  given  to  one  of  these  over  the 
other  depends  upon  its  flavor.  All  are  equally  wholesome,  and 
equally  suitable  for  the  occasions  when  a  physician  wishes  to  ad- 
minister starch  without  admixture. 

§  9.  ALCOHOLIC  DRINKS. 

Wine. — This  is  a  subject  terribly  overladen  with  literature,  his- 
torical, poetical,  industrial,  scientific,  and  occasionally  nonsensical. 
So  that  a  simple  purchaser  who  wants  to  know  how  to  get  a  good 
wholesome  glass  of  wine,  has  no  small  difficulty  in  winnowing 
out  the  required  information  from  so  much  chaff. 

The  first  thing  a  householder  should  think  of  befbre  he  stocks 
his  cellar,  is — what  he  wants  the  wine  for.  Is  it  to  take  as  a 
regular  beverage,  or  on  festive  occasions  only?  Does  he  intend 
to  employ  it  for  himself  or  others  as  a  medicine,  or  to  drink  it 
only  because  it  is  nice  ?  Here  are  the  four  chief  uses  of  wine,  and 
different  wines  are  suitable  for  each. 

As  a  regular  beverage  for  a  healthy  person  there  is  no  wine  in 
the  English  market  equal  to  claret.  The  intelligence  and  perse- 
verance of  the  Bordelais  vintager,  improving  yearly  on  the  tradi- 
tional experience  of  centuries,  does  the  best  that  can  be  done  for  a 
very  good  grape.  Nothing  can  be  more  perfectly  made  than  the 


ON    THE    CHOICE    OF    FOOD.  73 

greater  part  of  the  low-priced  Bordeaux  wine,  now  brought  over 
direct  from  the  Gironde. 

Everybody  distinguishes  in  the  grape  three  parts,  viz.,  the 
pulp,  the  stones,  the  skin.  It  is  on  the  forms  and  degrees  of 
pressure  exerted  to  extract  the  juice,  that  the  presence  of  these 
several  parts  in  different  proportions  in  the  wine  depends.  In  the 
pulp  is  the  syrup,  which  ferments  into  alcohol,  the  amount  of* 
wltich  constitutes  the  value  of  the  wine.  So  as  much  of  that  as 
possible  is  got  out.  In  the  stones  are  essential  oils,  which  in  deli- 
cately graduated  moderation  are  wanted  to  contribute  to  the  for- 
mation of  vinous  ethers  as  a  "  bouquet."  In  the  skin  and  stalks 
is  tannin,  necessary  to  give  astringency  and  preserve  the  liquid 
from  mouldiness  ;  and  there  are  also  coloring  matter  and  extrac- 
tive, which  contribute  a  distinctive  hue,  a  thickness  or  "  body," 
and  fruitiness.  There  are,  too,  in  the  juice,  tartaric  acid  and  its 
salts  in  considerable  quantity,  and  citrates  and  malates  in  smaller 
amount ;  these  are  rather  necessary  evils  than  desirable  ingredients, 
and  the  owner  is  glad  to  see  his  must  deposit  the  greater  part  of 
them  in  the  "tartar" — a  product  of  the  vintage  for  which  he  ex- 
pressed his  dislike  by  the  bad  name  he  gave  it  in  the  old  days  of 
strong  language.1  There  is  also  some  nitrogenous  matter,  which 
in  undergoing  chemical  changes  acts  as  a  ferment,  and  having  done 
its  work,  ought  to  disappear,  lest  it  should  re-establish  fermentation 
when  not  required.  Now,  the  perfection  of  claret,  above  all  other 
wines,  consists  in  the  manufacture  being  so  conducted  that  each  of 
these  elementary  constituents  of  the  grape  is  expressed  in  exactly 
the  proportion  most  conducive  to  the  wholesomeness  of  an  alco- 
holic beverage. 

If  any  of  the  above-named  ingredients,  or  their  products,  ex- 
hibit themselves  conspicuously  in  the  perfected  liquor,  a  peculiar 
character  is  given  to  it,  which  causes  it  to  be  sought  out  for  real 
or  supposed  advantages,  or  avoided  for  real  or  supposed  evils. 
We  can,  thus,  classify  wines  as  they  appear  in  the  market,  in  the 
following  groups : 

1.  Strong  dry  wines. — In  these  the  syrup  of  the  must  has  been 


1  Sal  Tartari  =  "hell-salt;"  Cremor  Tariarl  =  "hell-scum,"  cream  of 
tartar.  The  history  of  the  word  is  not  known,  but  Paracelsus  found  it  in  use 
in  his  day. 


74  GENERAL    DIETETICS. 

in  large  proportion,  and  has  fermented  thoroughly  into  a  large 
proportion  of  alcohol. 

2.  Strong  sweet  wines, — Here  the  sugar  has  either  existed  natur- 
ally in  such  excess,  or,  more  commonly,  has  been  added  in  such 
excess,  as  to  stop  fermentation  and  remain  sweet. 

3.  Aromatic  wines,  whose  chief  feature  is  a  delicate  diffusible 
•odor  comparable  to  that  of  flowers,  and  thence  termed  "bouquet." 
This  depends  on  the  union  of  sundry  essential  oils  with  the  alto- 
hoi  in  a  nascent  state,  by  which  renanthic  and  other  volatile  ethers 
are  produced. 

4.  Acid  wines,  whence  the  natural  acid  cannot  be  eliminated 
without  destroying  the  flavor.     The  acid  in  them  is  mostly  tar- 
taric,  and  not  acetic,  as  in  wines  that  have  turned  sour.^ 

5.  Sparkling  wines. — Here  the  ferment  is  not  allowed  entirely 
to  exhaust  itself  before  bottling,  so  that  it  goes  on  slowly  under 
severe  pressure,  and  saturates  the  wine  with  carbonic  acid,  at  the 
same  time  giving  birth  to  flavors  which  would  not  otherwise  be 
produced,  and  to  very  exhilarating  ethers,  without  much  alcohol. 

6.  Perfect  wines,  where  as  many  of  the  above  qualities  as  pos- 
sible are  combined  without  interfering  with  one  another. 

7.  Rough  wines,  in  which  the  astringent  tannin  is  predominant. 
1.   Strong  dry  wines  are  well  represented  by  sherry,  which  is  the 

strongest  and  driest  of  all ;  and  it  is  ably  supported  by  Port, 
Madeira,  Marsala,  Johannisberg,  and  a  few  (very  few)  others  of 
the  products  of  Northern  grapes.  These  all  contain  too  much 
alcohol  to  drink  dietetically  ;  much  diluent  must  be  taken  at  the 
same  time  to  make  them  wholesome.  But  for  festive  use,  to  take 
a  glass  thereof  to  promote  conversation  and  good  fellowship,  they 
are  excellent.  And,  except  Marsala,  they  are  well  qualified  for 
that  post  by  agreeable  flavor. 

Constant  use  of  strong  wines  induces  a  congested  and  insensi- 
tive state  of  the  gastric  mucous  membrane,  which  prevents  its 
glands  from  secreting  freely,  and,  by  reflex  action,  affects  also  the 
salivary  glands ;  these  liquors  are  absorbed  slowly,  and  what 
sugar  remains  in  them,  and  much  of  the  alcohol  also,  becomes 
converted  into  acetic  acid,  which  fermentation  further  causes  the 
oleaginous  ingredients  in  the  food  to  become  rancid.  Thus  is 
generated  "  acidity "  of  stomach,  or  the  presence  of  an  undue 
amount  of  nascent  acids.  A  gouty  constitution  is  often  thus  in- 


ON    THE    CHOICE    OF    FOOD.  75 

augnrated  in  a  previously  healthy  person,  and,  what  is  worse,  is 
capable  of  being  transmitted  as  an  heirloom,  just  as  acquired  pecu- 
liarities are  handed  down  to  their  descendants  by  domestic  ani- 
mals. 

2.  Strong  sweet  wines  are  represented  in  England  by  Malaga, 
Alicante,  Constantia,  Tent,  Tokay,  Paxarete,  Malmsey,  the  ex- 
ported Lacryma  Christi,1  Frontignan,  Lunel.     They  are  fit  to 
drink  only  in  small  quantities,  and  are  best  appreciated,  with  a 
plain  biscuit,  when  the  stomach  is  not  full.     Thus  taken  they  are 
a  wholesome  substitute  for  tea. 

In  order  to  enhance  their  flavor  and  bouquet,  the  naturally  dry 
vintages  are  often,  either  during  the  manufacture  or  afterwards, 
made  sweet.  The  most  usual  and  least  objectionable  process  is 
checking  the  fermentation  by  the  addition  of  boiled  grape-juice, 
and  the  result  of  this  is  an  indubitably  less  wholesome  article. 
By  long  cellaring  the  sweetness  slowly  disappears,  and  the  fine 
flavor  remains ;  but  there  is  much  risk  of  decomposition,  which 
has  to  be  guarded  against  by  adding  an  excess  of  alcohol.  Almost 
all  the  port  now  to  be  had  is  an  artificial  wine  of  this  sort.  The 
port  drunk  by  our  grandfathers,  and  up  to  1820,  was  a  dry,  well- 
balanced  wine,  capable  of  being  kept  without  brandy  and  without 
damage  for  several  generations.  I  have,  in  Portugal,  tasted  some 
perfectly  sound,  which  had  been  in  a  private  cellar  upwards  of 
seventy  years.  But  the  summer  of  1820  was  an  extraordinary 
one,  and  produced,  in  the  Peninsula,  a  vintage  such  as  had  never 
been  seen  before,  and  the  wine,  by  a  preternatural  richness  of 
flavor  secured  a  fatal  popularity.  Since  then,  the  sole  ambition 
of  the  Oporto  merchant  is  to  imitate  1820.  He  has  more  or  less 
succeeded,  but  at  the  expense  of  British  digestions. 

3.  Aromatic  ivines. — Several   of  the  before-mentioned  have  a 
fine  bouquet,  but  what  are  intended  here  are  such  as  are  chosen 
for  their  aroma  almost  entirely. 

Moselle,  the  choicer  Rhine  wines,  first  quality  Chablis,  Chateau 
Yqucm,  several  Italian  wines  (such  as  Orvieto,  Monte  Pulciano, 
Capri,  d'Asti),  Champagne,  are  of  this  description.  They  bear 
carriage  badly,  and  have  to  be  prepared  for  the  voyage  by  artifi- 


1  Tlnit  used  for  home  consumption  is  a  badly  made  wine  which  will  not 
keep  till  it  is  ripe.     The  choicest  Lacryma  goes  to  Augsburg. 


76  GENERAL    DIETETICS. 

cial  additions.  So  that,  while  wholesome  in  their  native  land, 
they  are  apt  to  be  much  the  contrary  as  found  here,  and  besides 
have  often  lost  their  aroma  unless  they  are  brandied. 

4.  Acid  wines  must  be  in  justice  carefully  distinguished  from 
wines  which  have  turned  sour.     The  acid  of  the  latter  is  nascent 
vinegar,  whose  presence  indicates  the  probability  of  other  more 
noxious  acompaniments  of  decomposition  being  also  in  the  dam- 
aged liquid,  such  as  poisonous  moulds  and  fungi,  for  example ; 
but  some  wines  are  really  made  with  an  excess  of  acid,  consisting 
mainly  of  the  tartaric  and  its  supersalts.     This  happens  mostly 
to  the  growths  of  cold  countries,  such  as  the  Rhine  districts,  and 
the  environs  of  Paris.    White  Burgundy  wines  (of  which  Chablis 
is  the  best  known)  and  white  Bordeaux  wines  (Sauterne),  unless  in 
exceptional  years,  are  more  noted  for  their  acid  than  for  their 
aroma.      They  are  best   adapted  for   taking   with   rich,  greasy 
dishes,  and  suit  well  the  dietary  of  the  luxurious  districts  where 
they  are  grown.     They  are  an  agreeable  adjunct  to  the  usual  in- 
gredients of  salad  dressing. 

5.  Sparkling  wines. — Champagne,  St.  Peray  (from  the  Rhone), 
Seyssel  (or  "Swiss  Champagne"),  Sparkling  Moselle,  Vino  d'Asti, 
are  the  best  known.     Good  champagne  is  by  far  the  wholesomest, 
and  with  a  minimum  of  alcohol,  possesses  remarkable  exhilarating 
power,  from  the  rapid  absorption  of  its  vinous  ether  diffused  by 
the  liberated  carbonic  acid.     Sillcry  mousseux  contains,  according 
to  M.  Cyr's  table,  only  from  9  to  1 1  per  cent,  of  absolute  alcohol, 
but  to  a  sinking  fever  patient,  a  glass  will  give  twice  the  energy 
that  can  be  obtained  from  a  glass  of  brandy.     The  other  efferves- 
cing wines  will  be  drunk  only  by  those  who  are  reckless  or  igno- 
rant of  consequences. 

The  test  of  a  sparkling  wine  is  to  leave  it  uncorked.  If  it  be 
vapid  after  twenty-four  hours,  it  is  bad,  and  it  is  good  in  direct 
ratio  to  the  length  of  time  it  retains  its  sparkle  and  aroma.  That 
which  roughens  the  teeth  should  never  be  again  tasted  ;  it  is  made 
of  cider  and  rhubarb  stalks;  the  roughness  is  from  the  malic  acid 
it  contains. 

All  these  five  classes  of  wine  prudence  will  reserve  for  festive 
purposes  and  occasions;  the  wise  man  who  wishes  to  enjoy  life, 
will  make  them  always  exceptional,  for  as  idlers  have  no  holidays, 
so  perpetual  feasters  miss  all  the  pleasures  of  variety ;  but  I  am 


ON    THE    CHOICE    OF    FOOD.  77 

quite  sure  that  the  not  infrequent  manufacture  of  occasions  for 
domestic  rejoicing,  a  birthday,  a  wedding  anniversary,  a  harvest 
home,  a  horse  sold,  the  planting  of  a  tree,  the  calving  of  a  cow,  a 
daughter  presented  at  court,  or  cutting  her  first  tooth,  or  any 
other  good  stroke -of  business,  is  a  great  promoter,  not  only  of  love 
and  happiness,  but  of  personal  health.  Let  the  beverages  which 
celebrate  the  occasion  be  chosen  for  their  peculiar  and  exceptional 
flavors.  If  they  are  good  of  their  class,  the  moderate  use  will 
not  shorten,  but  both  cheer  and  lengthen  life. 

6.  Perfect  wines. — By  this  term  are  intended  such  as  possess  the 
virtues  derived  from  the  presence  of  alcohol,  of  water,  of  sugar, 
of  ethereal  flavors,  of  fruity  extractive,  and  of  acids,  without  any 
of  them  being  so  predominant  as  to  mask  the  others,  or  to  require 
artificial  additions  for  the  preservation  of  soundness  and  flavor. 
An  enormous  acreage  is  devoted  to  the  production  of  red  wines  of 
this  character  in  the  department  of  the  Gironde  and  other  places 
in  France  of  similar  climate.  We  give  the  nanle  of  "  claret  "  to 
the  whole  of  them,  which  is  better  than  pedantically  endeavoring 
to  affix  geographical  distinctions.  One  of  the  merchant-princes 
of  Bordeaux,  a  statesman  of  the  highest  integrity,  gave  me  some 
years  ago  a  hint  which  I  have  found  of  the  greatest  service  in 
the  diagnosis  of  wine-dealers.  "  When,"  said  he,  "  a  tradesman 
offers  you,  at  anything  but  the  very  highest  price,  our  wines  with 
the  name  of  an  estate  attached  to  them,  he  is  giving  currency  to  a 
deception.  If  he  uses  the  terms  of  First,  Second,  and  Third 
Quality  clarets,  it  is  so-far-forth  an  evidence  of  honesty."  The 
wholesale  houses  and  brokers  buy  up  from  farmers,  many  of 
whom  do  not  make  half-a-dozen  hogsheads  a  year,  all  but  the 
small  quantity  which  is  kept  to  store  as  "vintage"  wines,  vins  de 
luxe,  and  indeed  much  that  is  quite  equal  in  quality  to  these 
speculative  articles.  The  produce  is  mixed  under  the  superin- 
tendence of  cellarers,  who  at  Bordeaux  form  a  sort  of  hereditary 
caste,  handing  down  their  secrets  from  father  to  son,  and  adding 
fresh  knowledge — 

"Till  old  experience  doth  attain 
*To  something  of  prophetic  strain." 

The  mixed  wine  is  classed  as  premiere,  secondc,  and  troisieme 
qualite,  not  from  any  comparative  superiority  in  wholesomeness, 


78  GENERAL    DIETETICS. 

but  according  to  the  price  it  will  fetch  in  the  market.  Thus,  a 
much  better  general  result  is  secured  than  if  it  were  kept  separate, 
as  is  to  a  considerable  extent  done  on  the  Rhine. 

If  an  exporter  wishes  to  pass  off  some  of  this  blended  liquid  as 
the  production  of  some  special  vineyard,  he  accomplishes  his  ob- 
ject very  often  by  adding  an  artificial  scent.  If  he  wants  to  sell 
(say)  Chateau-Latour,  he  uses  nuts  or  almonds,  or  something 
which  smells  like  them  ;  if  his  ambition  leads  him  to  aim  at 
Clmteau-Lafitte,  he  adds  a  whiff  of  violets  also;  if  Leoville  be  his 
object,  violet  alone  is  probably  enough.  Others  seem  flavored 
with  cherries.  When  the  wine  is  originally  good,  it  is  not  likely 
that  its  wholesomeness  can  be  seriously  interfered  with  by  this 
fraud. 

But  the  same  cannot  be  said  when  imperfect  wines,  not  tempered 
by  admixture,  or  damaged  wines,  are  cured  and  fortified  for  ex- 
port with  flavors,  and  body,  and  alcohol.  The  fault  of  the  two 
former  is  not  so  much  that  they  are  actively  deleterious,  which  is 
not  known  to  be  the  case,1  as  that  they  hide  the  nauseousness  of 
an  unwholesome  article ;  and  the  same  might  be  asserted  of  the 
alcohol,  if  it  were  inserted  in  the  form  of  ripe  French  brandy,  but 
the  price  of  that  would  diminish  the  profits  too  much,  and  new 
corn  or  potato  spirit,  full  of  the  poisonous  oil  of  grain  (amylic 
ether),  is  used. 

Against  the  adulteration  of  claret  which  does  not  pretend  to  be 
anything  else  than  "  first,"  "  second,"  or  "  third  "  quality,  we  have 

1  The  substances  sold  by  adulterators  and  druggists  for  flavoring  alcoholic 
liquors  are,  according  to  Dr.  Hassall,  cocculus  indicus,  grains  of  paradise, 
capsicum,  ginger,  quassia,  wormwood,  orris  root,  carraway  and  coriander 
seeds,  orange  powder,  liquorice,  honey,  sulphuric  acid,  cream  of  tartar,  alum, 
carbonate  of  potash,  hartshorn  shavings,  nux  vomica,  gentian,  chamomilo, 
tobacco,  opium,  juniper  berries,  angelica  root,  and  bitter  almonds.  The  quan- 
tities used  of  the  active  drugs  are  infinitesimally  small,  and  would  be  nauseous 
if  employed  in  noxious  doses.  In  a  trade  circular  headed  "  Important  Infor- 
mation for  Practical  Men,"  Eichler's  Keceipts  for  Liquors  teaches  how  to  use 
also  "  tincture  of  green  tea,"  "raisins,"  "figs,"  "St.  John's  bread,"  "  rhat- 
any,"  "catechu,"  "elderberry,  cherry  and  huckleberry  juice,"  "brown 
sugar,"  "yeast  " — and  so  far  we  know  what  we  are  about.  But  as  much  can- 
not be  asserted  when  we  take  in  hand  a  mysterious  "  wine  coloring,"  and  still 
less  when  the  ill-omened  name  of  "  body  preparation  "  is  given  to  one  of  the 
drugs  recommended.  (See  Keport  of  State  Board  of  Health  of  Massachusetts, 
1873,  p.  167). 


ON    THE    CHOICE    OF    FOOD.  79 

the  valuable  safeguard  of  the  enormous  quantity  that  is  made,  and 
the  small  profits  which  could  be  got  out  of  the  labor  and  risk  of 
adulterating  it. 

The  commoner  Burgundies  and  the  red  Rhone  wines  run  our 
claret  very  hard  in  the  race  for  perfection ;  they  err  in  containing 
too  much  fruity  extractive,  which,  except  the  wine  happens  to  be 
very  strong  in  alcohol,  causes  decomposition.  They  do  not  keep 
well,  and  must  be  drunk  off  directly  they  are  ripe,  or  they  become 
unwholesome;  but  it  is  only  just  to  say  that  they  are  much  im- 
proved lately,  and  there  seems  little  doubt  that  the  scientific  ad- 
vice of  M.  Pasteur  and  others  is  calculated  to  improve  them  still 
further.  The  cause  of  un \vholesomeness  in  Burgundy  is  usually 
the  re-establishment  of  fermentation,  through  the  formation  of 
mouldiness  in  the  bottle.  To  detect  the  presence  of  this  de- 
structive action,  cork  lightly  down  about  two-thirds  of  a  bottle  of 
the  wine,  shake  it  well  for  half  a  minute  or  so,  and  let  it  stand  : 
if  there  is  any  carbonic  acid  set  free,  so  as  to  expel  the  cork  too 
readily,  the  Burgundy  is  unwholesome,  and  it  will,  if  drunk  daily, 
produce  feverishness,  tension  of  the  eyeballs,  throbbing  of  the 
arteries,  dry  furred  tongue,  and  indigestion. 

The  grand,  old-fashioned  vintage  Burgundies,  such  as  Cham- 
bertin,  Clos  Vougeot,  etc.,  do  not  produce  these  effects,  as  they 
are  sufficiently  alcoholized  not  to  decompose ;  but  their  price  and 
their  strength  fit  them  only  for  holidays.  They  should  be  treated 
like  port,  and  taken  in  a  single  glass  with  some  exceptionally 
prime  dish,  such  as  venison  or  a  saddle  of  four-year-old  mutton. 
The  primest  Burgundies  are  those  which  have  a  peculiar  odor  of 
wall-flowers. 

Beaujolais  was  introduced  a  few  years  ago  from  the  Macon 
market  by  means  of  some  choice  specimens,  but  it  has  not  sus- 
tained its  first  reputation.  It  is  apt  to  turn  sour,  and  at  the  best 
has  very  little  bouquet. 

The  Hungarian  wines  have  been  lately  widely  advertised  as 
superior  to  claret.  Some  of  them  have  certainly  pleasant  fruity 
flavors,  but  they  do  not  ripen  well  in  the  cellar,  and  are  liable 
to  decomposition.  They  are  inferior  to  the  produce  of  French 
vineyards  at  the  same  price. 

7.  Rough  wines  owe  their  character  to  the  relatively  large  pro- 
portion of  tannin  which  they  contain.  They  have  usually  a  bril- 


80  GENERAL    DIETETICS. 

liant  tint,  but  are  deficient  in  alcohol ;  and  their  principal  use  in 
the  trade  is  to  mix  with  others  to  impart  color  and  keeping  qual- 
ities. The  Vin  de  Cahors  and  Roussillon  come  under  this  cate- 
gory ;  the  latter,  being  stronger  in  alcohol  than  the  majority  of 
rough  wines,  appears  in  the  markets  in  its  own  name ;  at  the  mer- 
chants', and  in  public  houses,  as  "Burgundy  Port."  In  M.  Cyr's 
table  it  is  stated  to  contain  16.68  per  cent,  of  absolute  alcohol,  as 
against  17.63  per  cent,  assigned  to  sherry,  and  20  per  cent,  to 
port.  The  ordinary  drink  of  the  population  in  wine  countries 
usually  consists  of  these  rough  beverages;  but,  however  beneficial 
they  might  be,  which  is  questionable,  it  would  be  useless  to  recom- 
mend them  to  those  who  can  procure  something  more  palatable. 

Beer. — The  only  thing  to  be  guarded  against  in  malt  liquors  is 
sourness,  which  needs  no  comment. 

Spirits. — This  is,  in  every  respect,  the  worst  form  in  which  al- 
cohol can  be  habitually  consumed.  To  continue  to  produce  the 
desired  effect  it  is  necessary  to  continuously  increase  the  strength 
or  the  frequency  of  the  dose.  Almost  all  the  cases  in  which  in- 
jury to  physical  health  has  been  traced  to  alcohol,  are  in  reality 
due  to  spirit-drinking. 

Distilled  liquors  are  by  no  means  to  be  considered  as  merely 
dilutions  of  their  chief  ingredient.  The  products  of  recent  distil- 
lation are  always  deeply  saturated  with  the  poisonous  amylic 
ether,  which  the  manufacturers  call  "oil  of  grain"  or  "fusel  oil." 
It  is  not  an  adulteration,  for  gladly  would  the  distillers  get  rid  of 
it,  and  would  pay  largely  anybody  able  to  teach  them  how  to  do 
so  quickly  and  cheaply.  But  it  is  much  more  injurious  to  health 
than  any  possible  adulteration.  I  had  once  an  idea  that  this 
waste  product  might  be  made  of  economical  use,  as  a  medicine  or 
otherwise,  and  gave  it  to  a  considerable  number  of  persons  in 
doses  of  from  one  to  ten  drops.  The  consequences  were  invaria- 
bly feverishness  and  furred-tongue,  and  often  headache  and  throb- 
bing of  the  temples. 

After  cellaring  for  a  year  or  so,  a  great  part  of  this  poisonous 
ingredient  disappears  by  decomposition,  leaving  only  peculiar 
flavors.  And  a  quicker  mode  of  producing  the  same  effect  is  to 
let  the  spirit  drip  slowly  through  the  air,  at  the  cost,  of  course,  of 
much  loss  by  evaporation.  But  new,  unmellowed  spirit  must  be 


ON    THE    CHOICE    OF    FOOD.  81 

absolutely  prohibited  even  from  occasional  or  medicinal  use  in  the 
dietary. 

If  "fusel  oil"  cannot  be  detected  by  its  peculiar,  but  not  easily 
described,  odor,  it  may  usually  be  made  evident  by  pouring  some 
boiling  water  on  the  spirits  or  wine,  and  letting  the  mixture  stand 
in  a  small  room,  or  close  cupboard,  for  the  night.  It  is  then  dif- 
fused through  the  air.  It  may  also  be  discerned  in  the  breath  of 
the  consumer.  Chemists  have  not  helped  us  to  any  quantitative 
analysis  of  this  obnoxious  substance. 

§  10.  WATERS. 

It  is  only  exceptionally  fortunate  people  that  have  a  chance  of 
choosing  what  water  they  are  supplied  with.  Still,  it  is  of  prac- 
tical use  to  know  what  are  the  good  and  the  bad  features  of  each 
sort;  especially  the  bad,  in  order  that,  if  they  are  exhibited,  the 
source  may  be  avoided  altogether,  or  the  dangers  provided  against. 

Distilled  water,  as  it  is  condensed  from  steam,  is  the  ideal  of  per- 
fect purity.  It  has  not  even  air  in  it,  and  therefore  tastes  flat  and 
metallic.  But  it  makes  capital  tea,  beer,  or  any  other  infusion  or 
decoction. 

The  principal  bad  feature  it  can  exhibit  is  derived  from  its  very 
purity.  From  the  absence  of  salt,  it  dissolves  and  takes  up  in  so- 
lution any  lead  it  may  come  across.  So  that  in  ships,  or  any  other 
places  supplied  by  condensing  engines,  frequent  analysis  of  the 
water  with  sulphuretted  hydrogen  should  be  made,  lest  it  should 
be  poisoned  by  the  pipes  or  cisterns. 

Rain  water  may  be,  and  often  is,  equally  pure.  It  is,  in  fact, 
as  it  falls,  steam  condensed  in  the  great  condensing  apparatus  of 
the  sky.  But  it  is  better  aerated  than  distilled  water.  For  cu- 
linary purposes,  for  washing,  and  the  like,  it  is  well  adapted. 
But  it  is  apt  to  pick  up  dirt  on  the  surfaces  where  it  is  collected, 
and  being,  like  the  last,  free  from  salts,  also  is  readily  infected  by 
lead. 

River  water  is  principally  rain-water  which  has  been  filtered  by 
passing  through  the  surface  soil.  A  new  risk,  here,  has  to  be 
guarded  against,  namely,  that  of  contamination  by  refuse  organic 
matter  in  a  state  of  decay,  but  not  yet  sufficiently  oxidized  into 
harmlessness.  The  latter  object  is  naturally  secured  by  the  mo- 

6 


82  GENERAL    DIETETICS. 

tion  and  aeration  of  a  flowing  stream,  and  the  greater  part  of  the 
resultant  dirt  falls  to  the  bottom,  while  the  chloride  of  sodium 
and  other  salts  make  the  water  actually  more  agreeable  and  diges- 
tible. A  purified  river  is  the  best  drinking-water  one  can  have, 
but  unhappily  it  is  not  yet  quite  evident  what  length  of  exposure 
is  necessary  to  secure  its  purification,  and  there  is  the  uncomforta- 
ble feeling  that  any  organic  matter  may  possibly  be  of  a  highly 
poisonous  sort.  Water  from  this  source  should  not  be  drunk  un- 
less it  be  quite  free  from  taste  and  smell,  either  naturally  or  after 
filtration ;  or  unless  we  can  trace  to  an  obviously  harmless  source 
any  taste  or  smell  we  find  in  it.  By  "harmless"  I  mean  such  an 
impurity  as  peat,  derived  from  superficial  layers  of  that  substance. 
This  is  not  only  harmless,  but  positively  a  security,  showing  that 
the  water  has  passed  through  one  of  the  best  natural  filters  in  the 
world ;  and  a  slight  tinge  of  it  is  by  no  means  unpleasant. 

AVater  containing  sewage  to  any  appreciable  extent  gives  off  a 
fetid  smell  just  before  the  boiling  temperature,  and  may  be  easily 
detected  in  this  way.  The  boiling  temperature  renders  it  safe  from 
germs  capable  of  communicating  infectious  disease,  but  it  does  not 
make  it  clean  or  wholesome. 

The  readiest  test  of  the  presence  of  unoxidized  organic  matter, 
is  to  put  a  drop  of  "  Condy's  patent  ozonized  water  for  toilet  pur- 
poses "  in  a  tumbler  of  water.  If  the  purple-lake  hue  thus  com- 
municated remains  for  a  quarter  of  an  hour,  the  liquid  is  safe ;  if 
it  vanishes,  there  is  more  organic  matter  than  there  should  be. 
The  organic  matter  may  indeed  be  soap-suds,  or  some  equally  in- 
nocent portion  of  our  fated  peck  of  dirt ;  but,  on  the  other  hand, 
it  may  be  the  germ  of  typhoid  fever  or  cholera  derived  from  a 
source  painful  to  contemplate.  As  wise  persons  who  have  to  do 
with  strange  dogs  always  caustic  a  bite,  however  free  from  hydro- 
phobia the  animal  may  appear  to  be,  so  it  is  prudent  always  to 
filter  river  water  unless  we  have  tested  its  absolute  purity. 

Iron  is  sometimes  spoken  of  as  an  impurity  which  is  a  recom- 
mendation, rather  than  otherwise,  of  a  water,  because  iron  is  given 
by  us  as  a  tonic.  But  I  cannot  agree  with  that  opinion.  We  do 
not  give  iron  to  healthy  persons;  for  if  we  did,  we  should  often 
find  what  I  have  observed  in  some  who  habitually  use  iron-stained 
water,  viz.,  deficient  nutrition,  dyspepsia,  and  obstinate  anaemia. 
And  when  we  give  iron  to  the  sick,  we  give  it  as  a  drug,  and  not 


ON    THE    CHOICE    OF    FOOD.  83 

as  a  drink,  and  only  in  short  courses,  and  moreover  we  do  not 
order  it  to  be  used  in  cookery.  I  should  strongly  advise  iron 
springs  and  streams  to  be  avoided. 

Lakes  are  perfected  rivers.  The  organic  matter  has  first  been 
oxidized  by  motion  and  exposure,  and  then  is  deposited  by  rest. 
When  Londoners  see  the  happiness  and  saving  due  to  the  bring- 
ing a  few  feet  of  Loch  Katrine  through  Glasgow,  no  wonder  that 
their  mouths  water  for  Bala,  or  some  other  available  lake.  Mean- 
while, the  existing  companies  do  their  best  to  imitate  lakes,  by 
letting  their  property  rest  in  raservoirs  before  distribution. 

Marshes  are,  however,  in  a  very  different  position  from  lakes. 
They  are  not  deep  enough  to  allow  the  organic  and  mineral  mat- 
ters to  be  dropped  out  of  the  way,  and  moreover  they  are  filled 
with  decaying  weeds  and  insects.  It  is  an  observation  due  to 
Hippocrates,  that  the  drinking  of  marsh  water  causes  enlargement 
of  the  spleen,  and  many  observations  have  decidedly  confirmed 
this  evidence  of  the  conveyance  of  ague  poison  by  drinking-water. 
Hippocrates  remarks  also  on  the  unhealthiness  of  marsh  water, 
arising  out  of  its  frequent  change  of  temperature ;  it  is  hot  in 
summer,  and  icy  in  winter,  thus  tending  to  produce  catarrhs.1 

Springs  are  underground  streams.  Before  the  surface  drainage 
which  supplies  them  has  got  down  to  their  level,  it  has  been  most 
thoroughly  filtered  of  organic  matter,  so  they  are  clear  and  bright. 
Moreover,  being  kept  at  a  considerable  barometric  pressure,  they 
hold  a  good  deal  of  carbonic  acid  in  solution,  which  renders  them 
sparkling  and  exhilarating.  But  the  presence  of  that  carbonic 
acid  makes  them  take  up  also  a  good  deal  of  lime,  iron,  and  other 
mineral  constituents  of  the  deep  soil.  They  are  "  hard,"  that  is 
to  say  their  lime  forms  an  insoluble  compound  with  soap,  curdles 
it  and  prevents  it  cleaning  your  hands.  This  is  a  very  good  test 
of  the  presence  of  an  excess  of  lime;  and  another  is  a  deposit  tak- 
ing place  in  the  teakettle  after  the  carbonic  acid,  which  suspends 
it,  is  driven  off  by  heat.  Hard  waters  dry  up  the  mucous  mem- 
branes just  as  they  do  the  skin,  arrest  digestion,  and  thus  cause 
gout,  gravel,  and  stone  to  be  prevalent  in  the  districts  watered  by 
them. 

Ordinary  hard  waters  owe  their  objectionable  quality  to  carbo- 


1  Hippocrates,  vol.  i,  p.  532-3,  edit.  Ktitin. 


84  GENERAL    DIETETICS. 

nate  of  lime  made  soluble  by  the  presence  of  carbonic  acid,  and 
derived  from  the  chalk  in  the  strata  through  which  they  have 
passed.  This  is  in  a  great  measure  cured  by  the  means  by  which 
it  is  detected,  as  above-mentioned,  viz.,  by  boiling.  But  in  cer- 
tain districts,  as  for  example  in  the  Vale  of  Belvoir,  the  hard 
waters  contain  sulphate  of  lime,  which  is  not  thrown  down  by 
heat.  So  no  boiling  will  rectify  them,  and  in  such  districts  rain 
or  surface  water  should  be  employed  for  drinking  and  cooking. 

Shallow  wells  have  the  same  virtues  and  faults  as  rivers.  They 
are  peculiarly  liable  to  be  poisoned  by  the  neighborhood  of  house 
drains.  Deep  wells  have  rather  tne  characters  of  springs.  The 
tests  of  goodness  are  applicable  accordingly.  And  here,  it  may 
be  remarked,  that  the  tests  mentioned  above  are  merely  hints  to 
excite  suspicion,  selected  as  readily  applicable  without  the  appa- 
ratus of  a  laboratory.  If  a  doubt  arise,  no  analysis  should  be 
trusted  but  that  of  a  special  analyst,  for  which  full  instructions  are 
given  by  Dr.  Parkes1  and  others. 

The  perfections  of  water  are  to  be — 

1.  Soft. 

2.  Clean. 

3.  With  air  and  carbonic  acid  in  it,  to  make  it  refreshing. 

4.  With  salt  in  it,  sufficient  to  make  it  tasteless,2  and  to  prevent 
its  too  ready  contamination  by  lead. 

Mineral  waters  for  dietetic,  as  distinguished  from  medicinal, 
use,  should  have  the  same  virtues.  Manufacturers  s"ay  that 
"  soda  water  "  is  always  most  popular,  if  it  contains  a  minimum 
of  soda,  that  is  to  say  if  it  is  simply  good  drinking-water  aerated. 
And  a  very  delicate  beverage  is  the  fashionable  "Apollinaris 
water,"  the  salts  in  which  are  in  proportions  to  render  it  most  soft 
and  velvety  to  the  palate,  and  not  in  such  quantity  as  to  give  it 
any  medicinal  action.  It  is  as  good  for  health  as  the  water  of 
Loch  Katrine. 


1  Practical  Hygiene,  b.  i,  chap,  i,  sect.  5. 

2  Tastelessness  is  sometimes  looked  upon  as  an  evidence  of  the  purity  of 
water  ;  but  this  is  not  strictly  true.     Distilled  water,  of  absolute  purity,  has  a 
decided  metallic  flavor,  which  is  removed  by  the  addition  of  salt  and  air. 
The  probability  is  that  by  these  additions  it  is  more  assimilated  to  the  fluids 
of  the  body,  and  therefore  is  more  digestible,  more  quickly  absorbed.     For  the 
same  reason  unboiled  albumen  is  proverbially  tasteless. 


ON    THE    CHOICE    OF    FOOD.  85 

Potash  and  Lithia  waters  should  be  used  by  invalids  only. 

I  have  heard  some  parents  object  to  their  grown-up  sons  drink- 
ing soda  water,  under  the  idea  that  it  diminishes  their  chance  of 
seeing  grandchildren  around  their  hearth.  I  have  not  been  able 
to  trace  any  such  baleful  influence. 

Toast  and  water  (made  by  pouring  boiling  water  on  a  burnt 
biscuit  and  two  or  three  cloves)  is  a  wholesome  drink,  for  it  se- 
cures the  neutralization  of  all  organic  matter. 

Barley  water,  if  well  boiled  for  about  a  quarter  of  an  hour,  is 
also  a  good  formula  for  making  hard  water  more  digestible.  The 
"  pearl  barley  "  of  which  it  is  made,  should  be  washed  with  two 
waters  before  using,  and  about  two  ounces  to  the  quart  is  gener- 
ally found  enough  to  make  a  drink  to  quench  thirst.  Some  very 
thinly  shaved  lemon  rind  is  the  wholesomest  flavoring. 

Those  who  drink  for  pleasure  lemonade,  orangeade,  ginger  beer, 
and  the  like,  should  always  prepare  them  at  home.  The  small 
dealers,  who  brew  what  is  sold,  are  prone  to  use  the  cheaper  tar- 
taric,  malic  (as  found  in  rhubarb),  oxalic,  and  even  mineral  acids 
instead  of  oranges  and  lemons.  And  they  employ,  as  flavors,  the 
amylic  ethers,  or  "  fruit  essences,"  most  deleterious  drugs. 

Cups  of  various  kinds  are  wholesome  drinks,  if  not  too  much 
fortified  with  spirituous  liquors.  Cura9oa  should  never  be  al- 
lowed to  enter  into  their  composition ;  the  peel  of  a  Tangerine 
orange  ground  over  with  a  lump  of  sugar,  will  give  all  the  flavor 
without  the  poison.  Borage  and  cucumber  rind  are  not  injurious. 

Ice, — In  Dr.  Bidder's  experiments  on  the  gastric  juice,  he 
found  that  low  temperature  does  not  exercise  any  deleterious  in- 
fluence upon  it.  When  absolutely  frozen,  it  dissolved  albumen  as 
well  as  ever,  though  it  was  quite  spoiled  by  heat.1  Again,  the 
secretion  of  glands  is  arrested  by  feverishness  of  system,  or  by 
local  elevation  of  animal  warmth  above  the  normal  degree,  and, 
in  hot  weather  or  hot  rooms,  it  cannot  but  be  beneficial  to  the 
stomach  to  reduce  the  unusual  temperature  to  which  the  over- 
heated blood  has  brought  it.  Ice,  therefore,  is  one  of  the  most 
generally  useful  additions  to  the  dietary  of  both  sick  and  healthy 
which  the  energy  of  modern  trade  has  made;  and  the  ice-box  puts 


1  Die  Verdauungssiifte,  Bidder  and  Schmidt,  Experiments  ix,  1,  2,  x,  1,  xi, 
1,  xvi,  xvii. 


86  GENERAL    DIETETICS. 

a  daily  supply  within  reach  of  us  all.  The  only  time  when  ice  is 
found  injurious  is,  during  the  exhaustion  and  real  cooling  conse- 
quent on  violent  exercise  and  perspiration.  Pond  ice,  glacier  ice, 
and  snow  are  much  inferior  to  the  lake  ice  with  which  the  Eng- 
lish market  is  supplied.  They  contain  foreign  and,  sonietimas, 
organic  matters,  and  melt  sooner.  Ice  machines  are  to  be  recom- 
mended as  a  means  of  obtaining  cold,  when  the  best  ice  is  out  of 
reach.  They  are  so  frequently  improved,  that  it  is  unadvisable 
to  say  which  is  the  best  at  present. 


ON    THE    PREPARATION    OF    FOOD.  87 


CHAPTER  III. 

ON  THE   PREPARATION   OF   FOOD. 

THE  most  important  element  in  cooking  is,  indubitably,  the 
cook.  And  the  most  important  of  a  cook's  virtues  is  shown  in 
the  selection  of  food.  A  good  cook  is,  to  a  certain  extent,  born, 
not  made ;  and  if  born  deficient  in  necessary  faculties,  the  novice 
should  be  made  to  understand  that  she  has  mistaken  her  mission. 
The  necessary  faculties  are  those  of  accurate  taste  and  smell — 
with  which,  joined  to  enthusiasm  and  punctuality,  she  may  become 
a  useful  and  honored  member  of  society — without  which,  she  is 
simply  an  incumbrance.  The  tests  to  try  her  by  are  plainly 
cooked  eggs,  joints,  and  vegetables.  If  she  regularly  sends  these 
up  in  a  state  to  give  a  zest  to  her  master's  appetite,  let  him  think 
no  trouble  or  expense  wasted  in  teaching  her  whatever  she  desires 
to  learn ;  if  they  excite  disgust,  harm  rather  than  good  is  done  by 
her  technical  knowledge  of  those  disguises  of  inferiority  known 
as  "  made  dishes."  Cleanliness  may  be  taught,  a  variety  of  re- 
ceipts may  be  bought,  but  a  delicate  nose  is  beyond  price.  Choose 
a  cook  young,  choose  her  carefully,  and  treat  her  liberally. 

It  is  an  old  remark  that  a  good  cook  shows  generally  a  bad 
temper.  There  is  more  truth  in  it  than  in  most  proverbs;  for  the 
fact  is  that  in  half-educated  persons,  just  indignation  is  apt  to 
bear  the  appearance  of  wrath  ;  and  the  needful  rebukes  to  over- 
reaching tradesmen,  and  the  disappointments  which  one  who 
loves  her  work  must  feel,  if  her  enthusiasm  is  not  appreciated, 
beget  a  sharpness  of  tongue  and  manner  difficult  to  endure. 
Nevertheless,  it  is  wise  to  bear  and  forbear,  and  to  keep  an  effi- 
cient servant  when  you  have  got  one. 

This  is  not  a  cookery-book,  and  therefore,  of  course,  the  details 
of  the  kitchen  could  not  be  entered  into,  even  were  I  equal  to  the 
task.  It  is  not  the  business  of  these  pages  to  teach  how  to  make 
food  nice,  except  so  far  as  that  quality  indirectly  bears  upon  its 
wholesomeness.  All  that  can  be  attempted  is,  to  po*int  out  a  few 


88  GENERAL    DIETETICS. 

particulars  in  which  the  preparation  of  food  bears  upon  what  is 
known  of  the  physiology  of  digestion  and  the  economics  of  nu- 
trition. And  in  a  future  chapter  will  be  discussed  the  extent  to 
which  a  physician  should  interfere  with  the  cook  in  the  adminis- 
tration of  food  to  his  patients,  in  sickness. 

No  kitchen  is  complete  without  an  open  range.  It  is  impossi- 
ble to  have  a  properly  roasted  joint  by  any  other  means,  as  I 
learned  by  visiting  the  private  premises  of  a  "  Patent  Kitchener" 
manufacturer,  and  finding  there  an  old-fashioned  fire-place  in  full 
operation.  He  cared  too  much  for  his  diet  to  employ  his  own 
works.  Experience  has  led  me  to  question  even  the  economy  of 
the  closed  fire  in  practical  working. 

Roasting  is  the  most  perfect  mode  possible  of  preparing  meat 
for  the  table.  The  heat  radiated  from  the  open  range  coagulates 
the  outer  layer,  of  albumen,  and  thus  the  exit  of  that  which  is 
still  fluid  is  prevented,  and  it  becomes  solidified  very  slowly,  if  at 
all.  The  areolar  tissue  which  unites  the  muscular  fibres  is  con- 
verted by  gradual  heat  into  gelatin,1  and  is  retained  in  the  centre 
of  the  mass  in  a  form  ready  for  solution.  At  the  same  time  the 
fibrin  and  albumen  take  on,  according  to  Dr.  Mulder,2  a  form 
more  highly  oxidized  and,  .especially  in  the  case  of  the  former, 
more  capable  of  solution  in  water.  The  fat  also  is  melted  out  of 
the  fat-cells,  and  is  partially  combined  with  the  alkali  from  the 
serum  of  the  blood.  Thus,  the  external  layer  of  albumen  be- 
comes a  sort  of  box,  which  keeps  together  the  valuable  parts  till 
they  shall  have  undergone  the  desired  changes  by  slow  heat — a 
box,  however,  permeable  by  the  oxygen  of  the  free  surrounding 
air,  so  that  most  of  the  empyreumatic  oils  generated  by  the  char- 
ring of  the  surface  are  carried  oif.  As  these  are  neither  agreeable 
nor  wholesome,  the  loss  is  a  gain.  There  is  also  an  acrid  volatile 
product,  acrolein,  produced  by  the  burning  of  the  fat,  which  is 
better  removed. 

The  first  part  of  roasting  should  therefore  be  got  through 
rapidly,  by  close  exposure  to  a  bright  hot  fire,  in  an  open,  well- 
ventilated  kitchen.  By  this,  the  gravy  is  retained  in  the  meat, 

1  Not,  however,  the  sarcolemma,  which  an  experiment  of  Professor  Kolli- 
ker's  seems  to  remove  from   the  class   of  substances  yielding  gelatin.     See 
Kolliker's  Mikj-os.  Anat. ,  vol.  ii,  p.  250. 

2  Quoted  in  Moleschott's  Diatetik,  p.  450. 


ON    THE    PREPARATION    OF    FOOD.  89 

till,  at  the  first  incision,  it  flows  out  of  a  reddish  color.  After  the 
complete  coagulation  of  the  albumen  on  the  surface,  the  joint 
should  be  removed  a  little  further  off  from  the  fire,  so  as  to  roast 
gradually  through. 

The  whole  time  of  roasting  depends  partly  on  the  weight  of  the 
joint,  partly  on  the  sort  of  meat. 

Brown  meats,  such  as  beef,  and  mutton,  and  goose,  require  a 
quarter  of  an  hour  for  each  pound. 

Veal  and  pork,  the  same,  with  five  or  six  minutes  added  at  the 
end  to  make  sure  of  absence  of  red. 

White-fleshed  birds  take  somewhat  less ;  for  example,  a  turkey 
of  8|  Ibs.  (according  to  M.  Gouffe)  only  an  hour  and  three 
quarters,  a  capon  of  4  Ibs.  fifty  minutes,  a  fowl  of  3  Ibs.  half  an 
hour,  a  pheasant  thirty-five  minutes,  a  partridge  fifteen  minutes. 

The  fire  should  be  thoroughly  lighted  before  commencing,  and 
kept  up  evenly  ;  two  gills  of  broth  put  in  the  pan,  and  the  larger 
roasts  basted  with  it  five  or  six  times,  the  smaller  three  times, 
during  roasting.  Before  removal  from  the  spit,  some  thick  fleshy 
part  should  be  pressed  with  the  finger,  to  ascertain  that  it  is  soft. 
Uncooked  parts  retain  their  elasticity.  All  these  times  have  been 
calculated  on  the  understanding  that  there  is  no  draught  to  lower 
the  temperature  between  the  fire  and  screen,  for,  however  airy  and 
well-ventilated  the  kitchen  should  be,  such  an  irregular  distribu- 
tion of  heat  is  most  noxious,  and  overthrows  all  calculations  for 
the  clue  roasting  of  meat. 

M.  Brillat-Savarin  pronounced  on  est  ne  rdtisseur ;  in  this  he 
does  not  show  his  usual  wisdom,  for  an  eye  on  the  clock  will  sup- 
ply the  lack  of  an  instinctive  knowledge  of  time. 

Roasting  properly  conducted  is  the  most  scientific  and  whole- 
some, and  on  that  score  the  most  economical  mode  of  dressing 
meat. 

Baking  naked  meat  at  a  high  temperature  is  a  feeble  imitation  ; 
and  the  way  cooks  have  of  baking  first,  and  then  browning  the 
outside,  so  completely  reverses  the  needful  order  of  the  required 
processes  that  it  may  be  designated  a  fraud.  Baked  meat  is  ill- 
flavored  and  indigestible  from  the  saturation  of  the  substance 
with  empyreuma  ;  but  it  is  not  so  when  the  temperature  is  mode- 
rate, and  when  the  materials  are  further  defended  from  it  by  a 
layer  of  some  bad  conductor  of  heat,  such  as  a  thick  pie-dish,  or 


90  GENERAL    DIETETICS. 

a  crust,  or  a  coat  of  clay  (as  practiced  by  the  gipsies).  No  empy- 
reuma,  or  product  of  charring,  is  then  formed ;  and  the  fat  and 
gravy  which  ooze  out,  assist  in  the  cooking.  The  process  goes  on 
even  after  the  dish  is  taken  out  of  the  oven,  if  it  is  kept  hot  by 
being  enveloped  in  a  thick  flannel,  or  placed  in  one  of  Silver's 
Norwegian  cooking  boxes.  The  "  Cornish  pasty "  is  the  most 
perfect  dinner  that  a  laborer,  or  sportsman,  or  artist,  can  have 
brought  to  his  midday  rendezvous.  Meat  or  fish,  and  potatoes, 
or  anything  in  short  that  the  taste  or  purse  dictates,  are  enveloped 
in  a  thick  solid  crust,  baked  slowly,  and  then  packed  in  several 
layers  of  woollen.  The  basketful  will  keep  warm  for  hours,  and 
is  the  ne  plus  ultra  of  outdoor  refreshment. 

Vegetables  and  fruit  demand  the  same  slow  treatment.  For  a 
large  party,  apple  or  gooseberry  pie  should  be  baked  all  night  in 
an  old-fashioned  red  dairy  pan. 

Eggs  should  not  be  used,  or  at  any  rate  very  sparingly,  in 
bakes ;  for  submitted  to  heat  for  a  long  period,  their  albumen  be- 
comes more  and  more  tough  and  insoluble. 

Rapid  boiling  has,  in  a  minor  degree,  the  same  case-hardening 
effect  on  the  meat  as  roasting  ;  but  the  interior  albumen  seems,  by 
this  process,  more  hardened  and  less  digestible.  In  boiling  a 
joint,  the  heat  should  be  kept  up  for  five  or  six  minutes.  Then, 
it  should  be  cooled  down  by  the  addition  of  three  pints  of  cold 
water  for  each  gallon  of  boiling  water,  and  retained  at  that  heat.1 

In  boiling  fish,  the  addition  of  salt  to  the  water,  or  the  use  of 
sea-water,  makes  the  flesh  firmer,  and  retains  the  flavor  in  the 
interior ;  but  in  making  stock  for  souchees,  the  softer  the  water  the 
better. 

Mutton  is  best  boiled  in  hard  water,  for  the  same  reason  as  fish. 

Slow  boiling  makes,  it  is  true,  a  nourishing  soup,  but  converts 
the  muscular  fibre  into  a  mass  of  hard  strings,  which,  eaten  or  not 
eaten,  are  in  nine  cases  out  of  ten  equally  wasted.  They  are  to 


1  That  is  to  say,  reduced  with  water  at  50°  from  212°  Fahrenheit  to  170°, 
or  to  the  extent  of  42°.  The  formula  in  the  text  is  given  as  a  specimen  of  the 
best,  perhaps  the  only,  mode  of  directing  cooks  how  to  reduce  temperature. 
The  female  mind  abhors  meters  of  all  kinds,  and  degrees  Fahrenheit  men- 
tioned in  our  orders  would  infallibly  entail  their  rejection,  as  only  fit  for  hos- 
pital nurses.  Medical  men  cannot  be  too  cautious  to  avoid  introducing  any- 
thing reputed  "  chemical  "  into  the  kitchen. 


ON    THE    PREPARATION    OF    FOOD.  91 

be  found  in  the  faeces,  exhibiting  all  the  beautiful  transverse  striae 
of  their  original  state,  quite  unaffected  by  their  intestinal  journey. 

The  utility  of  Soups  and  Broths  depends  on  several  circum- 
stances which  modify  the  advantages  accruing  from  their  liquid 
state.  In  the  first,  place,  heat  seems  to  have  an  effect  in  some 
degree  proportioned  to  the  period  of  application  to  albumen,  ren- 
dering it  more  or  less  insoluble,  at  the  same  time  that,  to  a  deli- 
cate palate,  there  is  a  decided  loss  of  flavor.  Thus  soups  and 
stews  which  are  kept  too  hot,  are  wholesome  enough  during  the 
first  few  hours,  may  be  digested  at  a  railway  refreshment  room  for 
some  hours  after,  but  on  the  second  or  third  day  give  the  rash 
stranger,  beguiled  into  a  cheap  French  dinner,  an  almost  certain 
diarrhoea.  Though  finely  divided,  the  minute  fragments  of  mus- 
cular fibre  seem  to  be,  individually,  rendered  insoluble  by  con- 
tinued heat. 

Then,  again,  a  high  temperature,  too  long  continued,  extracts 
from  the  meat  all  its  gelatin — an  innutritious  material,  which  en- 
velops the  fragments  of  fibrin  in  the  stomach,  and  prevents  their 
being  acted  upon.  And  this  is  all  the  more  likely,  when  an  over- 
anxious cook  tries  to  make  the  soup  what  she  calls  "good"  (that 
is,  strong,  stiff,  and  gluey)  for  invalids. 

Again,  if  the  soup  is,  by  straining,  made  clear  and  ornamental, 
a  great  deal  of  the  most  valuable  part  of  it  is  removed  :  the  bouilli, 
if  not  over-boiled,  contains  the  chief  constituents  wanted  as  nour- 
ishment. 

This  subject  will  be  reverted  to  when  discussing  cookery  for 
the  sick. 

Soup  is  rendered  more  wholesome  and  nutritious  for  healthy 
persons  by  the  addition  of  vegetables.  Thus,  the  "Administra- 
tion de  1' Assistance  publique"  in  France,  adopted,  by  the  advice 
of  a  commission  of  physiologists  and  physicians,  a  formula  for  the 
preparation  of  bouillon  embracing  this  addition.  Reduced  to  ap- 
proximate English  measures  the  recipe  is  as  follows : 

"Water, 4  pints. 

Meat  (with  bono),   .......  2  Ibs. 

Carrots,  turnips,  and  other  vegetables,    ...  6  ozs. 

Salt, foz. 

Roast  onions,  ........  i  oz.1 

1  Cyr,  De  I'Alimcntation,  p.  49. 


92  GENERAL    DIETETICS. 

It  may  be  safely  commended  for  adoption  in  "  soup-kitchens." 

Boiling  is  a  form  of  cookery  peculiarly  adapted  to  vegetables. 
Dr.  Paris1  remarks  that  it  deprives  them  of  a  considerable  portion 
of  contained  air,  which  is  injurious  to  digestion  when  in  excess. 
Potatoes  should  be  steamed  or  boiled  in  their  skins,  and  not  so 
long  as  for  them  to  fall  to  pieces  from  the  breaking  of  the  starch- 
granules  ;  when  skinned,  they  ought  to  retain  their  shape.  On 
the  other  hand,  the  cabbage  tribe  and  carrots  can  hardly  be  boiled 
too  long.  It  is  essential  that  soft  water  should  be  employed,  and 
it  is  the  securing  this,  that  makes  steaming  such  an  advisable  form 
of  boiling,  for  steam  is  of  course,  soft  water. 

Particular  care  should  be  taken  that  vegetables  are  thoroughly 
boiled  soft  all  the  way  through,  and  dried  on  a  cullender. 

A  certain  quantity  of  oleaginous  matter  renders  vegetables,  in 
which  there  is  much  combined  water,  less  massive  in  the  stomach. 
Thus,  roast  potatoes  are  better  for  the  addition  of  some  fresh  but- 
ter, and  mashed  potatoes  for  a  little  cream  beaten  up  with  the 
puree  after  it  has  been  passed  through  a  sieve;  and,  again, 
milky  rice  pudding  does  not  collect  into  a  lump  as  plain  rice  is 
apt  to  do.  In  making  the  latter  dish  up  for  baking,  eggs  should 
never  be  used.  Baked  white  of  egg  is  the  most  insoluble  form  of 
albumen  possible. 

Plain  boiled  rice  should  always  have  a  little  fresh  cold  butter 
mixed  up  with  it.  In  that  way  it  will  serve  as  an  accompaniment 
of  meat  at  dinner. 

Stewing  has  the  advantage  over  dry  baking,  that  there  is  no 
charring  or  formation  of  empyreumatic  gases ;  and  the  heat  is  not 
too  great.  The  principal  objection  to  it  is  that  the  meat  often 
gets  saturated  Avith  the  fat  gravy,  and  is,  thus,  too  rich  for  some 
persons. 

It  is,  however,  not  nearly  so  liable  to  this  objection  as  Frying. 
Unless  conducted  with  great  skill,  this  process  coats  each  particle 
of  the  food  with  a  medium  difficult  of  penetration  by  the  gastric 
juice,  for  it  is  oily,  whereas  the  secretion  of  the  stomach  is  watery. 
Butyric  acid  and  other  rancid  and  empyreumatic  educts  are  formed, 
and  disturb  digestion,  producing,  not  rarely,  flatulence  and  heart- 
burn. The  art  consists  in  frying  "  lightly,"  as  cooks  phrase  it, 

1  Cyclopaedia  of  Practical  Medicine,  i,  576. 


ON    THE    PREPARATION    OF    FOOD.  93 

that  is  to  say,  quickly  and  evenly,  and  with  constant  motion,  so 
that  the  high  heat  required  does  not  char  any  part.  For  those 
who  do  not  dislike  the  flavor  of  oil,  it  is  a  more  manageable  me- 
dium than  butter,  and  generally  turns  out  a  lighter  dish.  Good 
Lucca  or  Provence  oil  is  also  less  likely  to  be  sophisticated  than 
bought  butter. 

Hashiny  is  not  to  be  encouraged.  From  the  two  processes  that 
are  gone  through,  the  animal  fibre  is  too  much  hardened  to  be 
readily  digested.  Cold  meat  is  wholesomer,  and  may  be  made  as 
palatable  with  mayonnaise  or  some  such  sauce.  If  it  must  be 
done,  at  least  let  a  water-bath  (bain  marie)  be  used. 

Marinating,  that  is,  baking  in  vinegar  and  water  with  layers 
of  bay-leaves  and  pepper-corn,  is  suitable  for  the  more  oily  kinds 
of  fish.1 

Sroiling  imparts  a  peculiar  tenderness  to  the  meat,  by  the  rapid 
hardening  or  browning  of  the  surface,  preventing  the  evaporation 
of  the  juice.  It  is,  in  fact,  roasting  applied  to  small  portions  of 
meat.  Tradition  commends  it  as  a  suitable  cookery  for  the  meat 
of  persons  in  training;  but,  perhaps,  in  no  sort  of  dish  does  it 
shine  so  much  as  in  fish. 

In  the  preparation  of  mixed  dishes  and  in  seasoning  it  should 
be  a  general  and  almost  universal  rule  that  the  different  ingre- 
dients should  be  as  far  as  possible  cooked  separately.  The  reason 
is  obvious, — each  article,  from  its  texture,  requires,  for  its  perfec- 
tion, to  be  submitted  to  heat  for  a  different  period.  Too  long  ex- 
posure destroys  its  flavor  and  solubility.  To  take  familiar  exam- 
ples,— an  egg  if  made  into  a  custard,  or  just  coagulated,  is  tasty 
and  wholesome ;  but  if  baked  for  half  an  hour  in  a  pudding  it 
becomes  useless  as  an  article  of  food.  Spices  lose  nearly  all  their 
flavor,  whije  retaining  all  their  irritating  qualities,  if  mixed  in  a 
dish  before  boiling;  yet  if  heated  up  separately  and  for  a  shorter 
time,  they  retain  it,  and  will  suffice  in  much  smaller  quantity. 
Soup,  on  the  other  hand,  requires  less  boiling  than  the  vegetables 
which  are  usually  put  in  it.  If  boiled  together,  the  latter  are 
therefore  sure  to  be  underdone.  If  baked  in  a  tartlet,  jam  loses 


1  Another  mode  of  wholesomely  cooking  oily  fish,  such  as  sprats,  pilchards, 
or  herrings,  is  to  stew  or  bake  them  in  a  deep  dish  in  layers,  with  a  layer  of 
breadcrumbs  between  each. 


94  GENERAL    DIETETICS. 

all  fruity  odor  and  taste,  and  sinks  into  the  paste.  It  should  be 
only  barely  heated  after  the  paste  is  done.  Just  warm  an  oyster, 
it  is  sapid  and  digestible ;  bake  it  in  a  beef-steak  pie,  it  is  leathery 
and  insoluble.  It  ought  to  be  put  in  cold,  just  before  the  dish 
comes  to  table.  Onions  require  long  cooking;  but  the  other 
seasoning  herbs  usually  used  in  broths  should  not  be  sprinkled  in 
till  a  late  stage  of  the  boiling. 

The  effects  of  salting  are  often  misunderstood.  It  is  well  known 
that  living  exclusively  on  salted  meat  produces  scurvy ;  and  it  is 
imagined  that  the  injury  to  the  system  arises  from  the  saline  mat- 
ter thus  introduced  into  it.  Such,  however,  is  not  the  case.  Chlo- 
ride of  sodium  is  such  a  large  constituent  of  our  blood  that  it  can- 
not possibly  be  noxious.  The  unwholesomeness  of  salt  meat,  as 
an  article  of  diet,  depends  on  its  deficiencies,  not  on  its  excesses : 
it  has  lost,  according  to  Baron  Liebig's  calculation,  half  its  nutri- 
tive value  by  the  removal  of  its  fluids  and  salts  by  the  brine ; 
and  the  dried-up  remnant  is  difficult  of  solution.  Soaking  in 
water  may  soften  and  remove  the  salt,  but  it  does  not  restore  its 
nutritive  value. 

Smoking  and  Drying  are  not  quite  so  injurious  to  the  texture  of 
the  flesh  as  salting.  It  would  seem  that  in  the  latter  the  hard- 
ening process  goes  on  continuously ;  in  fact,  the  salt  remains  and 
continuously  extracts  the  aqueous  constituents.  But  the  drying 
takes  place  once  for  all,  and  the  article  gets  no  worse  when  it  is 
once  prepared,  until  decomposition  occurs.  These  modes  of  prep- 
aration seem  peculiarly  adapted  for  fish,  which  naturally  perish  so 
readily,  and  which  are  more  injured  than  even  meat  by  salting. 

Tinned  meat  cannot  make  any  claim  to  a  recommendation  ex- 
cept on  economical  grounds.  When  heated  up  for  the  table  it  is 
too  much  cooked  to  be  digestible  or  pleasant.  It  is  best  eaten  cold, 
with  some  of  its  own  jelly,  and  salad  or  mayonnaise  sauce. 

The  process  of  "tinning"  meat  is  well  known  to  consist  in  the 
expulsion  of  air  from  the  material  by  means  of  heat ;  and  it  is  to 
be  feared  that  so  long  as  this  procedure  alone  is  employed,  the 
injury  from  the  excess  of  temperature  is  unavoidable.  The  aim 
of  the  inventor  should  be,  to  effect  the  same  object  by  the  aid  of 
air-pumps  in  the  cold. 

Ice  seems  to  promise  more  favorable  results  than  the  last-named 
device,  for  preserving  meat  during  its  conveyance  over  long  dis- 


ON    THE    PREPARATION    OF    FOOD.  95 

tances — from  the  overstocked  producer  to  the  hungry  consumer. 
The  attempt  lias  hitherto  failed  from  several  avoidable  causes ; 
but  the  Committee  of  the  Society  of  Arts,  who  have  taken  up  the 
matter,  are  sanguine  of  final  success  in  putting  the  Australian 
fresh  meat  butcher  in  direct  communication  with  the  English 
laborer.  It  should  be  remembered  that  meat  which  has  been  thus 
preserved  requires  immediate  cooking,  as  it  quickly  goes  bad  from 
the  change  into  a  higher  temperature  of  air.  It  should,  if  possi- 
ble, be  brought  home  in  an  ice-box,  and  kept  there  till  wanted. 

Vegetables  preserved  by  drying  undergo  an  interstitial  harden- 
ing of  the  tissues  which  renders  them  insoluble  in  the  saliva,  as 
may  be  observed  by  their  want  of  flavor.  They  are  inferior  to 
fresh  vegetables  for  use  in  preventing  scurvy — indeed  they  seem 
inferior  to  lime-juice  for  that  purpose — so  that  they  cannot  be 
wholesome  for  the  healthy.  It  is  a  fact,  not  explained  as  yet, 
that  long  transport,  especially  by  sea,  however  rapid,  has  a  some- 
what similar  deleterious  effect  on  vegetables ;  so  that  we  do  not 
get  the  advantage  which  might  have  been  anticipated  from  the 
increased  rapidity  of  communication  with  distant  supplies.  A 
notable  instance  is  that  of  Algerian  peas. 

The  preservation  of  food  by  excluding  the  air  by  means  of  oil 
is  a  subject  which  requires  further  experimenting  upon.  Delicate 
fish,  such  as  sardines  for  example,  can  be  kept  in  this  way  for  a 
long  time;  and  from  time  immemorial  the  method  has  been 
adopted  for  wine  in  Italy.  A  thin  layer  of  fresh  oil  in  the  neck 
of  the  flask  obviates  the  necessity  of  a  cork  in  wine  not  intended 
to  travel,  and  is  much  more  efficient,  preventing  even  the  lightest 
and  most  perishable  liquors  from  turning  sour.  Potted  meats  and 
sausages  are  often  judiciously  preserved  by  a  layer  of  lard,  which 
seems  effectual  in  retaining  moisture  and  preventing  decomposi- 
tion. Why  do  we  not  apply  the  same  principle  to  the  storing  of 
jams,  gooseberries,  plums,  etc.,  for  winter  use? 

Preservation  with  sugar  has  the  disadvantage  of  introducing-  an 
ingredient  which  is  cloying  to  the  appetite,  a  mask  to  the  natural 
flavor  of  the  vegetable,  and,  moreover,  apt  to  generate  an  excess 
of  acid  in  the  stomach. 

As  a  rule,  forced  vegetables,  and  fruit  out  of  season,  are  not  to 
be  recommended.  The  natural  period  of  its  perfection  is  long 
enough  for  us  to  enjoy  each ;  and,  then,  a  change  is  as  wholesome 


96  GENERAL    DIETETICS. 

as  it  is  pleasant.  To  bring  them  to  table  sooner  gratifies  merely 
a  vulgar  ostentation  or  impatient  gluttony,  and  receives  its  just 
punishment  in  a  premature  weariness. 

Certain  articles  of  diet  yield  their  savors  best  when  their  valu- 
able ingredients  are  got  out  in  the  form  of  an  Extract.  An  illus- 
tration of  this  may  be  found  in  the  Guatemala  mode  of  preparing 
Coffee  and  Chocolate*  which  is  as  follows : 

"  Coffee  berries  are  used  that  have  been  stored  dry  one  year. 
Taking  enough  for  one  or  two  days'  consumption,  they  rub  them 
in  a  linen  cloth,  and  lay  them  in  the  sun  before  roasting.  This 
operation  is  always  performed  by  the  lady  of  the  house,  over  a 
quick  charcoal  fire,  in  an  iron  cylinder,  which  she  keeps  turning  for 
ten  or  fifteen  minutes,  till  the  berries  are  roasted  on  all  sides.  The 
most  esteemed  bean  is  the  '  peaberry '  (which  bears  the  round  mono- 
cotyledonous  form,  instead  of  the  dicotyledonous),  in  consequence 
of  its  browning  more  evenly.  It  is  not  a  different  species  of  coffee, 
but  an  accidental  variety,  more  common  on  some  trees  than  others. 
At  the  critical  moment  of  perfection,  the  berries  are  emptied  into 
a  basket  and  stirred  round  to  prevent  their  further  concoction. 
They  are  then  ground,  and  a  very  strong  liquid  extract  is  made 
from  them  by  infusion  in  hot  water.  A  common  percolating 
coffee-pot  will  serve  this  purpose,  and  save  straining.  A  dessert- 
spoonful of  this  essence,  with  either  boiling  water  or  boiling  milk 
poured  on  it,  forms  a  cup  which  is  the  invariable  bonne  bouche  of 
every  meal. 

"Cacao  trees  grow  wild,  and  are  also  cultivated  round  some 
Indian  villages ;  the  berries  are  dried  in  the  sun ;  and  an  Indian 
woman  generally  comes  to  your  hacienda  to  make  them  into  choc- 
olate. Kneeling  before  her  mill,  consisting  of  a  smooth  curved 
surface  with  a  heavy  stone  roller,  she  grinds  the  kernels  up  with 
an  equal  weight  of  sugar,  and  flavors  with  cinnamon  or  vanilla, 
the  latter  a  wild  product  of  the  forest.  It  is  ground  three  times 
over,  and,  when  in  a  smooth  paste,  is  cut  into  oblong  square  pieces, 
each  enough  for  one  cup.  It  is  then  dried  on  a  plate  over  a  char- 
coal fire.  When  required  for  use,  it  is  dissolved  in  boiling  water 
or  milk,  and  a  thick  froth  worked  on  the  top  of  each  cup  with  a 

1  Dictated  by  Mrs.  Osbert  Salvin. 


ON    THE    PREPARATION    OF    FOOD.  97 

swizzle-stick  or  whisk.  The  cup  is  often  filled  up  with  milk- 
cheese,  cut  into  small  dies." 

A  principle  of  rational  cookery,  much  overlooked  by  professors 
of  the  culinary  art,  is  that  each  article  of  diet  should  be  so  pre- 
pared that  its  own  natural  flavors  and  other  characteristics  should 
be  enhanced,  instead  of  being  masked  or  destroyed.  Condiments 
and  sauces  should  be  so  moderately  used,  as  never  to  be  a  promi- 
nent feature ;  and  then,  should  be  so  blended  and  balanced,  as  to 
make  it  difficult  to  identify  them.  There  seems  to  me  nothing 
Utopian  in  the  idea  of  a  universal  sauce,  adapted  to  all  sorts  of 
animal  food,  making  them  all  more  savory  and  more  wholesome 
at  the  same  time.1  There  is  ample  scope  for  individual  taste  in 
the  selection  of  the  variety  suited  to  the  user's  palate. 

One  is  almost  ashamed  to  mention  cleanliness  as  an  essential  in 
cookery,  the  idea  of  the  contrary  condition  in  eatables  is  so  re- 
pulsive ;  but  cooks  do  not  seem  aware  how  often  their  dishes  are 
unpalatable,  and,  therefore,  unwholesome,  solely  from  being  pre- 
pared in  a  vessel  which  has  a  disagreeable  flavor  remaining  in  it. 
Soap  is  sometimes  employed  in  washing  pots,  instead  of  soda ; 
and  the  taste  of  the  rank  train-oil  seems  to  adhere  to  the  metal, 
and  to  infect  a  succession  of  otherwise  excellent  material ;  and  so 
adheres  the  odor  of  onions,  and  of  several  other  condiments,  to  a 
steel  knife.  The  use  of  printed  paper  to  stand  glass  and  crock- 
ery upon,  in  cupboards,  is  also  objectionable,  as  the  oily  effluvium 
from  fresh  printing-ink  is  very  rank,  and  acrid,  and  penetrating, 
as  our  patients  who  suffer  from  hemorrhoids  well  know  to  their 
cost. 

Fish  is  an  article  very  often  spoilt  by  injudicious  endeavors  to 
make  it  palatable.  "Melted  butter,"  in  reality,  requires  the  hand 
of  a  first-rate  artist,  whereas  every  kitchen  maid  thinks  she  can 
concoct  it.  Unless  M.  Gouffe's  instructions  have  been  followed 
to  the  letter,  it  is  best  avoided  altogether.  A  few  drops  of  Chili 
vinegar,  or  black  pepper  vinegar,  or  elder  vinegar,  or  Worcester 

1  This  is  an  old  ambition,  see  Pepys's  Diary,  February,  10,  1661-9.  Tbe 
Duke  of  York  "  did  mightily  magnify  bis  sauce,  which  he  did  then  eat  with 
everything,  and  said  it  was  the  best  universal  sauce  in  the  world,  it  being 
taught  him  by  the  Spanish  ambassador;  made  of  some  parsley  and  a  dry  toast, 
beat  in  a  mortar  together  with  vinegar,  salt,  and  a  little  pepper;  he  eats  it 
with  flesh,  or  fowl,  or  fish.  .  .  .  By  and  by  did  taste  it,  and  liked  it  mightily." 

7 


98  GENERAL    DIETETICS. 

sauce,  or  a  slice  of  lemon,  or  a  sauce  made  by  boiling  pepper  and 
salt  in  plain  water  with  a  few  favorite  herbs,  assist  the  digestion 
of  the  fish,  whereas  greasy  sauces  impede  the  process,  chemically 
and  mechanically. 

Grilling  does  for  fish  that  which  roasting  or  boiling  does  for 
meat,  and  is  a  commendable  mode  of  preparation,  especially  as  it 
obviates  the  temptation  to  take  sauce. 

Those  professional  lectures  are  usually  the  most  instructive 
which  take  up  some  universally  known  and  simple  matter  relat- 
ing to  a  subject,  and  use  it  in  illustration  of  the  principles  in- 
volved in  the  art  to  be  taught.  To  exemplify  the  elements  of 
sanatory  cookery,  perhaps  nothing  could  be  more  fitly  chosen  by 
a  lecturer  than  the  cooking  of  an  egg.  First,  for  the  name — our 
great-grandmothers  (if  proverb  register  language  truly)  talked  of 
"  roasting  "  an  egg :  we  call  the  same  process  "  boiling,"  marking 
the  fact  that  there  is  no  essential  difference  between  the  two,  the 
end  of  both  being  the  same,  namely,  the  bringing  albumen  into  a 
mechanical  condition  more  suitable  for  the  digestive  viscera  than 
when  raw.  Then,  an  egg,  more  clearly  than  any  other  meat,  ex- 
hibits the  virtues  of  freshness,  and  the  vices  of  defects  in  that 
quality.  Boil  an  egg  warm  from  the  nest,  and  you  recognize  it 
by  its  creamy,  lightly  coagulated,  eminently  digestible  form  of 
albumen.  Even  by  next  day  it  is  less  perfect,  and  steadily  de- 
generates in  value,  till  it  becomes  the  most  hateful  of  poisons. 
Here,  may  be  pointed  out,  the  importance  of  selection  according  to 
external  obvious  qualities. 

Next,  should  come  a  scientific  picture  of  the  coagulation  of  al- 
bumen by  heat.  Albumen  begins  to  coagulate  at  14001  very 
slowly,  but  does  not  form  a  solid  mass  with  rapidity  under  the 
temperature  of  nearly  212°.  Till  it  has  formed  a  solid  mass  it 
is  easily  permeable  by  heat,  and  the  central  parts  are  solidified, 
therefore,  equally  with  the  exterior;  whereas,  coagulated  albumen 
is  a  bad  conductor  of  high  temperature;  and  if  the  outside  sets 
quickly  and  firmly,  the  inside  remains  light  and  semi-solid.  Boil 
an  egg  at  a  slow  heat,  and  it  is  not  cooked  till  hard  all  through ; 
put  it  into  quite  boiling  water,  and  the  white  sets  soon,  and  leaves 
the  albumen  of  the  yolk  soft.  This  illustrates  the  rules  given  a 

1  Simon's  Chemistry  (Day's  translation),  vol.  i,  p.  16. 


ON    THE    PREPARATION    OF    FOOD.  99 

few  pages  back,  about  applying  at  first  a  high  heat  in  roasting  and 
boiling,  and  afterwards  moderating  it,  when  the  hardened  surface 
lias  inclosed  the  deeper  parts  as  in  a  box.  The  shell  of  the  egg 
may  be  a  text  to  demonstrate,  how  in  baking  and  frying,  the  ex- 
ternal media,  the  crust  and  the  oil,  retain  the  whole  of  the  sub- 
stance, so  that  there  is  no  loss  during  these  economical  culinary 
operations,  though  the  meat  is  less  wholesome. 

Then,  that  this  loss  of  wholesomeness  is  due  to  the  saturation 
of  the  article  of  diet  with  the  products  of  dry  distillation,  and, 
also,  that  enhancement  of  natural  savor,  solubility,  and  whole- 
someness run  in  parallel  lines,  may  be  illustrated  from  the  obser- 
vations of  Beaumont  on  the  different  times  occupied  in  the  gastric 
digestion  of  eggs  in  several  conditions.  He  found,  for  example, 

Hours.  Minutes. 
Eggs,  whipped  and  diluted,  occupied  in  digestion,       .     1         30 


fresh  raw 

fresh  roasted 

soft  boiled  (or  poached) 

hard  boiled 

fried 


2  0 

2  15 

3  0 
3  30 
3  30 


It  may  be  observed  that  this  is  just  the  order  in  which  they  are 
tasty ;  that  is  to  say,  the  degree  in  which  they  come  with  facility 
into  contact  with  the  sensory  nerves  distributed  through  the  mu- 
cous membrane ;  so  that  pleasure  and  duty  here,  as  usually  in 
natural  operations,  become  one. 

General  rules  for  the  preservation  of  food  are  somewhat  decep- 
tive. They  lead  to  their  being  too  much  practiced  for  the  display 
of  the  pride  of  ingenuity.  The  fact  is  that  food  is  always  the 
worse  for  storing  in  respect  of  its  wholesomeness,  even  if  its  taste 
is  not  injuriously  affected. 

But  economical  reasons  exist  for  the  restricted  exercise  of  this 
art.  The  principle  consists  in  excluding  the  evil  oxidizing  influ- 
ences of  air  and  moisture.  In  dry  goods  this  is  done  by  keeping 
them  dry  and  warm  and  closely  covered  up.  Starch,  rice,  tapioca, 
sago,  macaroni,  vermicelli,  sugar,  sweetmeats,  jams,  salt,  and  dried 
and  salted  meats,  tea,  coffee,  etc.,  require  this  treatment.  And 
they  should  be  kept  in  a  different  cupboard  from  odorous  goods, 
such  as  candles  and  soap,  or  they  will  catch  the  objectionable 
flavor.  But  with  most  fresh  organic  substances  a  different  treat- 


100  GENERAL    DIETETICS. 

ment  is  necessary  to  the  attainment  of  the  same  end.  They  con- 
tain in  their  texture  itself  sufficient  moisture  and  air  to  oxidize 
them  into  decomposition,  and  the  more  stagnant  these  are  the 
more  surely  do  the  chemical  actions  result.  It  is  necessary, 
therefore,  to  let  them  have  free  ventilation  ;  their  external  surface 
should  be  frequently  wiped,  or  at  least  blown  over  by  a  current 
of  air,  so  as  to  let  the  old  moisture  escape  and  fresh  be  absorbed. 
Thus,  meat  should  hang  exposed  in  an  open  larder,  and  be  often 
dried.  Lemons  should  be  purchased  in  the  summer  and  sus- 
pended in  nets  for  use  at  the  time  when  they  are  dear.  Onions 
and  garlic  should  be  strung  up  in  an  outhouse  (not  the  larder). 
Parsley,  thyme,  mint,  and  other  herbs  should  be  dried  in  the 
wind,  out  of  the  sun,  put  each  into  a  separate  paper  bag,  and 
hung  up  in  the  kitchen.  Where  apples  and  pears  and  chestnuts 
are  stored,  the  window  should  be  left  open,  and  the  fruit  fre- 
quently turned.  Too  much  draught  makes  vegetables  withy;  so 
they  should  be  laid  on  a  stone  floor  behind  the  door.  Potatoes 
are  best  stacked  in  dry  sand. 

The  date  when  each  article  is  stored  should  be  written  down. 

Eggs  are  an  exception  to  the  usual  rule  respecting  organic  sub- 
stances. They  cannot  be  treated  in  the  same  way  by  reason  of 
their  structure,  yet  it  is  impossible  to  avoid  keeping  them  for  culi- 
nary purposes.  They  are  best  preserved  by  being  washed  over 
with  a  solution  of  gum  and  packed  in  a  square  box  of  bran, 
which  is  to  be  turned  over  a  quarter  of  a  turn  every  day. 


ON    DIGESTION.  101 


CHAPTER  IV. 

ON    DIGESTION. 

THE  most  recent  systematic  teacher  of  physiology  defines  diges- 
tion as  "  the  process  by  which  food  is  reduced  to  a  form  in  which 
it  can  be  absorbed  by  the  intestines  and  taken  up  by  the  blood- 
vi-sels."1  The  process  consists  in  the  aliments  being  passed  along 
a  canal,  thence  called  the  "  alimentary  canal,"  running  through 
the  body,  where  it  comes  in  contact  with  fluids  oozing  out  from 
various  glands,  which  mixing  with  it  dissolve  it,  and  reduce  it  to 
a  homogeneous  juice  or  "chyme." 

The  more  perfectly  and  quickly  this  end  is  attained,  the  more 
healthy  is  the  digestion. 

These  fluids  resemble  one  another  in  being  watery,  saline,  and 
albuminous,  like  the  serum  of  the  blood,  so  that  they  are  well 
adapted  for  passing  readily  through  the  mucous  membranes  by 
endosmose.  They  pass  in,  as  they  passed  out,  freely,  and  carry 
in  with  them  the  nutriment  prepared  in  the  alimentary  canal. 
But  there  the  resemblance  ceases;  and  the  differences  of  the  fluids 
poured  from  the  different  glands  are  very  marked,  and  their  ac- 
tions on  the  various  constituents  of  the  diet  are  strikingly  special- 
ized. 

1.  The  saliva,  secreted  from  the  glands  of  the  mouth,  is  alka- 
line, glairy,  and  adhesive,  and  possesses  the  power  of  converting 
very  rapidly  the  unabsorbable  starch  into  soluble  and  absorbable 
sugar. 

2.  The  gastric  juice,  secreted  in  the  thin  layer  of  gland  which 
lines  the  cavity  of  the  stomach,  is  acid,  and  can  dissolve,  so  long 
as  it  is  acid,  the  solid  albumen  and  fibrin  of  flesh  food. 

1  Dalton's  Human  Phyisology,  fifth  edit.  chap,  vi.,  whore  will  be  found 
a  complete  rSxumi  of  the  scattered  contributions  of  others  up  to  the  present 
time,  often  illustrated  and  criticized  by  the  light  of  the  author's  original  in- 
vestigations on  this  subject.  An  old  rfsumt  of  mine,  entitled  Digestion  and 
its  Derangements  (London,  1856),  is  out  of  date,  as  well  as  out  of  print. 


102  GENERAL    DIETETICS. 

3.  The  pancreatic  juice  is  again  alkaline,1  very  full  of  albumi- 
nous organic  matter,  and  capable  of  exerting  a  peculiar  influence 
on  fatty  matters.     It  disintegrates  them,  and  reduces  them  to  a 
state  of  emulsion,  so  that  the  mixture  of  fat  in  the  watery  fluid  it 
floats  in,  is  white  and  opaque.     In  this  creamy  state,  it  is  capable 
of  soaking  through  the  mucous  membrane  and  passing  into  the 
blood,  by  the  same  way  as  the  starch  and  fibrin. 

4.  The  bile  is  very  different  from  any  of  the  above  fluids  in 
chemical  reaction  and  contents,  and  it  does  not  appear  to  possess 
the  power  of  dissolving  starch  by  turning  it  into  sugar,  or  of  dis- 
solving fibrin,  or  of  emulsioning  fat  in  any  degree  equal  to  pan- 
creatic juice,  though  it  is  itself  of  a  soapy  nature,  as  is  shown  by 
the  commercial  use  of  ox-bile  by  carpet  cleaners  to  remove  grease- 
spots.     It  is  neither  acid  nor  alkaline,. but  it  possesses  considera- 
ble bleaching  powers,  and,  also,  arrests  decomposition  in  animal 
substances.     In  this  latter  capacity,  it  is  highly  conducive  to  our 
comfort  by  obviating  that  intolerable  odor  which  distinguishes  the 
excretions  of  patients  in  whom  the  bile  is  deficient.     But,  with 
all  this,  it  does  not  clearly  appear  how  any  of  its  known  physical 
properties  can  aid  in  the  constructive  assimilation  of  nutriment. 
Yet  aid  it  does,  most  decidedly.     If,  in  consequence  of  accident 
or  disease,  the  flow  of  bile  into  the  alimentary  canal  is  wholly  cut 
off,  the  animal  rapidly  emaciates,  and  dies  starved.     Even  when 
the  supply  of  bile  is  only  partially  diminished,  as  in  the  instance 
of  some  of  our  patients,  there  is  a  marked  deficiency  of  nutrition, 
shown  in  loss  of  weight  and  anaemia.     Now,  this  would  not  hap- 
pen if  bile  were  a  mere  excrementitious  fluid  containing  ingredi- 
ents resulting  from  the  disintegration  of  the  tissues,  and  designed 
merely  for   their  removal  from  the  body.      It  has  assimilative 
functions  to  perform  beyond  the  simple  drainage  of  the  blood, 
though  what  those  functions  are  can  be  expressed  only  in  the 
vaguest  terms  at  present,  and  the  most  prudent  and  most  recent 
physiologists  decline  to  give  a  definite  opinion  on  the  uses  of  the 
bile. 

5.  The  intestinal  juice  is  secreted  alkaline,  and  possesses  the 
power,  like  the  saliva,  of  converting  starch  into  sugar;  but,  unlike 


1  Dr.  Dobell  questions  its  alkalinity.     Perhaps  it  varies  with  the  state  of  the 
body. 


ON    DIGESTION.  103 

that  fluid,  does  not  lose  its  power  in  presence  of  an  acid.  It,  also, 
has  a  certain  solvent  power  over  albumen,  inferior,  indeed,  to  that 
of  the  stomach,  but  stronger  in  this  respect,  that  it  is  not  checked 
by  the  bile  or  pancreatic  juice. 

Thus,  we  see  that  a  meal,  as  it  passes  downwards,  is  irrigated 
first  by  a  watery  fluid  which,  as  it  dilutes  and  adds  to  its  bulk, 
dissolves  or  fits  for  absorption  a  great  portion  of  its  starchy  con- 
stituents. Then,  it  is  further  irrigated  by  a  still  more  dilute  fluid, 
which  dissolves  its  meaty  part.  Then,  the  fat  is  washed  out  of  it 
by  the  stream  of  pancreatic  juice.  And,  simultaneously,  the  bile 
is  poured  on  it  in  a  continuous  stream,  which  makes  it,  in  some 
unexplained  way,  more  easy  to  be  taken  up  as  nutriment.  After- 
wards, the  intestinal  juice,  oozing  out  in  small  quantities  through- 
out a  long  canal,  seems  fitted  to  make  up  the  deficiencies  of  any  of 
the  previous  solvent  acts. 

The  daily  quantities  of  these  fluids,  as  estimated,  mainly,  from 
the  results  of  Drs.  Bidder  and  Schmidt's  experiments,  may  be 
reckoned,  at  least,  to  equal  the  following : 

Of  saliva,   .........  3|  pints, 

Of  gastric  juice, 12   pint-, 

Ot  bile, 3}  pints, 

Of  pancreatic  juice,    .......  1£  pints, 

Of  intestinal  juice,      .......  £  pint, 

making  in  all  nearly  three  gallons.  Of  this,  ninety-six  per  cent, 
is  water,  of  which  only  so  much  passes  away  in  the  stools  as  pre- 
vents them  from  being  inconveniently  solid.  The  rest,  therefore, 
that  is  to  say  two  gallons  and  a  half,  is  restored  to  the  blood  by 
absorption. 

"  The  clearest  notion  we  can  gain  of  the  business  performed  by 
all  this  two  dozen  pints  of  water  which  exude  on  the  nuii-ons 
membrane  of  the  intestinal  canal,  and  are  by  the  same  membrane 
taken  up  again,  is  by  viewing  them  as  a  circulation.  It  is  con- 
stantly going  its  rounds  like  an  endless  chain,  finding  and  taking 
up  inside  the  solid  structure  of  the  body  substances  which  ought 
to  corne  out  and  be  got  rid  of,  finding  outside  nutriment  which 
the  body  wants,  and  conveying  it  in. 

"Truly,  when  a  man  contemplates  with  the  eye  of  the  reason 
this  unceasing  journey,  this  great  current  so  entirely 'removed  from 
the  cognizance  of  our  senses,  he  is  at  first  confounded  with  the 


104  GENERAL    DIETETICS. 

novelty  of  the  ideas  it  excites  (ingenti  motu  stupefactus  aquarum) 
and  almost  refuses  to  receive  them.  It  is  highly  important,  there- 
fore, to  bring  it  frequently  before  the  mind  till  it  becomes  habitual, 
for  there  is  no  view  of  living  phenomena  so  practically  weighty 
for  the  medical  man."1 

In  addition  to  this,  there  is  a  quantity  of  fluid  introduced  as 
beverage.  Water  passes  straight  through  the  mucous  membranes 
unchanged,  and  alcohol,  with  a  change  of  no  weighty  importance; 
and  dissolved  in  them  are  numerous  minor  substances  not  strictly 
dietetic,  though  valuable  by  acting  pleasurably  or  medicinally  on 
the  nervous  system. 

Rightly,  then,  has  digestion  been  likened  by  an  old  chemist  to 
a  process  of  "  rinsing  ;"2  all  that  is  required  is  washed  out  of  the 
alimentary  substances,  and  the  remains  passed  on  to  be  got  rid  of 
along  with  the  waste  products  of  chemical  life. 

Of  the  reason  why  these  various  secretions  are  able  to  digest  the 
various  constituents  of  our  food,  we  know  absolutely  nothing.  We 
find  an  albuminous  matter  in  saliva,  and  we  call  it  " ptyalin  ;"  we 
find  an  albuminous  matter  in  gastric  juice,  and  we  call  it  "pepsin;" 
we  find  an  albuminous  matter  in  the  pancreatic  juice  and  we  call 
it  "  panereatin ;"  but  the  only  distinguishing  point  about  each  is 
that  it  acts  upon  starch,  or  acts  upon  flesh-meat,  or  acts  upon  fat, 
just  as  the  fluid  from  whence  it  was  concentrated  acts.  Ultimate 
chemical  analysis  merely  shows  their  resemblances,  and  not  their 
differences.  The  nearest  approach  to  a  similar  proceeding  in 
nature  is  the  operation  of  malting,  where,  aided  by  heat  and  mois- 
ture, starch  is  turned  into  sugar  by  the  presence  of  "diastase;" 
and  it  is  remarkable  enough  that  when  albumen  is  artificially  dis- 
solved by  gastric  juice  in  the  laboratory,  a  peculiar  odor  some- 
what like  that  of  malting  is  given  off.  But  here  our  information 
ceases;  there  are  no  more  points  in  diastase,  to  distinguish  it 
chemically  from  ordinary  albumen,  than  there  are  in  pepsin  or 
panereatin. 

In  bringing  to  bear  upon  dietetics  the  observations  of  physiolo- 
gists, the  main  things  the  physician  has  to  consider  are  the  mechan- 
ical condition  in  which  the  food  should  be  brought,  the  influence 


1  Digestion  and  its  Derangements,  p.  31. 

2  Letheby  On  Food,  p.  48. 


ON    DIGESTION.  105 

of  its  several  solvents,  and  the  times  when  they  are  ready  to  re- 
ceive it. 

Chewing  is  the  first  provision  made  for  securing  a  due  mechan- 
ical condition.  The  perfection  consists  in  so  breaking  up  the 
mouthful  that  it  should  be  as  completely  as  possible  permeated  by 
the  saliva.  The  object  of  this  is,  in  the  case  of  meat,  to  soften  it 
in  preparation  for  swallowing  and  for  future  solution  in  the  stom- 
ach ;  in  the  case  of  starchy  matter,  to  convert  it  into  "glucose" 
or  sugar. 

"With  regard  to  the  amount  of  chewing  required  by  flesh  food, 
there  is  a  good  deal  of  popular  misconception.  Persons  with  bad, 
false,  or  tender  teeth  are  often  found  to  fancy  that  a  vegetable  diet 
is  more  suited  to  their  imperfect  power  of  mastication  than  an  ani- 
mal one ;  and  we  not  unfrequently  see  mothers  instructing  their 
children  carefully  to  chew  meat,  and  neglecting  the  same  precau- 
tion in  respect  of  vegetables.  Physiology  teaches  an  opposite 
caution.  It  is  desirable,  indeed,  that  the  jaws  should  break  up 
muscular  fibre,  lest  it  should  perchance  stick  in  the  gullet,  and  be 
certainly  difficult  of  penetration  by  the  gastric  juice  in  the  stom- 
ach ;  but  to  a  vegetable  aliment  the  performance  is  owing  of  more 
important  functions.  It  is  still  more  indispensable  that  it  should 
be  broken  up,  for  it  has  to  be  immediately  acted  upon ;  and  it  is 
indispensable  also  that  it  should  be  detained  in  the  mouth  till 
enough  saliva  to  convert  its  starch  into  glucose  has  been  secreted. 
Complete  mastication,  therefore,  important  for  both,  is  still  more 
important  for  vegetable  than  for  animal  food ;  and  the  leisurely 
performance  of  the  operation  cannot  be  prudently  omitted  by  a 
mixed  eater. 

It  may  serve  to  remind  us  of  this,  to  reflect  that  while  lions 
and  tigers  and  wild  dogs  bolt  their  food,  cows  not  only  spend  the 
greater  part  of  the  day  over  their  nibbled  meals,  but  give  it  a 
second  chewing  when  in  repose. 

Doubts  have  been  thrown  (Dalton's  Human  Physiology,  page 
116)  upon  the  importance  of  the  action  in  the  mouth  to  the  con- 
version of  starch  into  sugar;  but  the  following  easy  experiment 
seems  sufficiently  convincing.  Take  some  boiled  starch,  say  in 
the  shape  of  arrowroot,  and  heat  it  with  potassio-tartrate  of  copper. 
There  is  no  change  in  the  blue  color  of  the  salt.  Now,  put  some 
in  the  mouth,  and  hold  it  a  few  moments  only.  When  it  is  again 


106  GENERAL    DIETETICS. 

heated  with  potassio-tartrate  of  copper,  the  metal  is  precipitated, 
and  shows  by  its  brilliant  yellow  color  an  abundant  quantity  of 
sugar. 

The  salivar  then,  begins  to  convert  starch  into  sugar  immedi- 
ately ;  and  it  is  not  slow  to  extend  its  operation  to  the  whole  mass 
submitted  to  it.  A  protraction  of  the  foregoing  experiment  will 
show  this.  A  mouthful  of  boiled  arrowroot  held  in  a  healthy 
mouth  for  five  minutes,  will  showr  afterwards  scarce  a  trace  of 
starch  remaining. 

But  it  is  true  that  the  morsel  is  hardly  ever  allowed  to  remain 
in  the  mouth  long  enough  for  its  complete  conversion ;  hardly 
ever  is  it  sufficiently  boiled  and  chewed  for  the  saliva  to  affect  the 
whole  of  it.  Much  free  starch  and  free  saliva  must  be  carried 
down  the  resophagus.  During  its  passage  the  action  goes  on,  and, 
doubtless,  as  much  saccharine  transformation  takes  place  in  the 
latter  as  in  the  former  locality.  But  in  a  minute  or  two  it  must 
arrive  at  the  stomach,  and  there  the  acidity  of  the  viscus  is  said 
to  put  a  stop  to  the  saccharization.  On  this  arrest  of  the  salivary 
action  by  the  presence  of  acid,.  Dr.  Dalton's  opinion  of  its  slight 
Influence  in  digestive  solution  is  grounded.  Nevertheless,  once 
that  the  mass  has  passed  through  the  pylorus,  its  acidity  is  neu- 
tralized, the  action  of  the  remaining  saliva  recommences  on  the 
starch  yet  unconverted,  and  this  action  is  reinforced  by  the  intes- 
tinal juice. 

By  the  unconverted  starch,  I  mean  not  only  that  which  was 
unchanged  on  arriving  at  the  stomach,  but  also  a  good  deal  set 
free  since  that  stage  of  digestion.  For,  besides  the  saliva,  there 
practically  comes  into  play  in  the  solution  of  starch  that  which  I 
have  described  as  temporarily  arresting  it,  to  wit,  the  gastric  juice. 
Cookery,  even  when  most  efficient,  rarely  ruptures  the  whole  of 
the  granules.  Many  escape  in  the  best,  and  in  bad  cookery  the 
majority  escape.  They  cannot,  therefore,  be  affected  by  the  saliva, 
till  their  albuminous  envelope  has  been  dissolved  by  the  gastric 
juice.  Then,  the  amylaceous  matter  may  be  converted  into  sugar, 
either,  rapidly,  by  the  saliva  present,  or,  more  slowly,  by  the 
pancreatic  and  other  intestinal  secretions. 

For  the  reduction  of  starch,  therefore,  so  as  to  bring  vegetable 
food  into  a  condition  capable  of  easy  digestion,  the  first  point  is 
that  the  salivary  glands  should  secrete  a  sufficiency  of  fluid;  and 


ON    DIGESTION.  107 

this  not  merely  at  the  time  of  mastication,  but  that  they  should  go 
on  supplying  it  as  long  as  any  starch  remains  unconverted.  Then, 
it  appears  extremely  probable  that  the  gastric  glands  aid  the  future 
carrying  on  of  the  process,  though  the  acidity  of  the  stomach  pre- 
vent its  continuance  at  the  time  of  its  prevalence. 

Now,  the  salivary  glands  in  the  healthiest  persons  are  liable  to 
derangement  from  purely  external  circumstances  acting  on  the 
nervous  system.  Temporary  emotion  affects  them  temporarily, 
and  chronic  emotions  affects  them  chronically.  We  all  are  famil- 
iar with  the  dry  lips  of  the  coward,  the  lover,  the  pitiful,  and  how 
the  tongue  cleaves  to  thereof  of  the  mouth  when  pain  is  endured, 
or  when  bad  news  is  brought.  "Bread  eaten  in  sorrow"  can 
hardly  be  swallowed,  so  long  it  takes  to  moisten  the  morsel. 
Again,  bodily  exertion  parches  the  throat.  It  cannot  be  expected 
that  meals  of  mixed  food,  swallowed  when  the  body  is  under  the 
influence  of  the  circumstances  quoted  in  illustration,  should  be 
dissolved,  or  nourish  the  tissues  as  they  ought,  And  there  is 
nothing  surprising  in  the  fermentation  of  the  undigested  vegeta- 
bles, and  the  formation  of  flatulence  by  the  carbonic  acid  which 
results. 

Under  the  same  circumstances,  a  portion  of  the  solid  meat  re- 
mains undissolved,  and  is  often  thrown  away  unaltered  by  vom- 
iting or  diarrhoea;  for  the  stomach  is  influenced  contemporane- 
ously with  the  mouth,  as  is  clearly  shown  by  the  proverbial  loss 
of  appetite  from  mental  causes. 

It  is  in  this  arrest  of  secretion  that  the  sedative  action  of  alcohol 
comes  in  useful.  It  is  an  anaesthetic,  and  prevents  the  effect  of  the 
nervous  system  upon  the  alimentary  canal  from  being  so  deleteri- 
ous as  it  has  been  shown  naturally  to  be.  A  few  teaspoonfuls  of 
good  strong  wine  or  dilute  spirit  will  often  restore  the  lost  power  of 
taking  food,  and  is  an  instinctive  indulgence,  as  a  protective  against 
the  sundry  blows  inflicted  on  digestion  by  the  exciting  nature  of 
social  life  in  the  present  regimen  of  the  world.  It  is  possible  to 
imagine  a  state  of  society,  as  among  the  Pitcairn  islanders,  for  ex- 
ample, where  everybody  was  apparently  the  better  for  taking  no 
alcohol  in  any  form,  but  even  in  that  instance,  the  abstinence  does 
not  seem  to  have  lengthened  life,  and  it  is  certain  that  in  Europe, 
it  would  shorten  it  for  many  of  our  most  active  and  useful  citizens. 

Equally  important  is  the  absorption  of  the  sugar  thus  formed 


108  GENERAL    DIETETICS. 

from  the  starch.  In  health,  a  very  great  part  is  absorbed  in  the 
mouth  and  gullet,  sometimes  all,  for  chemists  have  great  difficulty 
in  finding  it  in  the  stomach,  unless  it  is  swallowed  in  excess. 
Some  of  it  is  probably  converted  into  the  lactic  acid,  which  aids 
the  solution  of  flesh  food,  and  the  rest  taken  up  as  sugar  by  the 
intestines.  Still,  even  in  health,  a  good  deal  of  both  starch  and 
sugar  escape,  and  appear  in  the  faeces.  But,  in  the  catarrhal  state, 
the  mucus  which  lines  the  membrane  is  an  almost  impermeable 
impediment  to  osmosis,  from  its  insolubility  in  water,  and  arrests 
absorption  in  proportion  to  its  quantity.  All  mucus  is  a  degree 
of  disease  and  every  Briton  knows  how  easily  it  is  formed  by 
very  slight  external  influences. 

It  is  clear,  then,  that  for  the  easy  digestion  of  starch  the  wrhole 
of  the  alimentary  canal  must  be  in  a  normal  condition,  and  the 
nervous  system  not  exhausted  by  recent  excessive  use. 

The  Mechanics  of  Digestion  refer  to  the  provision  which  is  made 
for  the  food  being  duly  brought  into  the  sphere  of  action  of  the 
solvents  described  above.  First  comes  Chewing,  the  importance 
of  which,  as  a  means  of  saturating  the  mass  with  saliva,  has  been 
already  insisted  upon.  Here  may  be  mentioned,  further,  the  im- 
portance of  its  completeness,  for  the  sake  of  reducing  muscular 
fibre  to  a  fine  pulp,  so  that  it  may  be  quickly  infiltrated  by  the 
gastric  juice  on  its  arrival  in  the  stomach. 

"In  the  human  subject,  the  teeth  combine  the  characters  of  the 
carnivora  and  the  herbivora.  The  incisors,  four  in  number  in 
each  jaw,  have,  as  in  other  instances,  a  cutting  edge  running  from 
side  to  side.  The  canines,  which  are  situated  immediately  behind 
the  former,  are  much  less  prominent  and  pointed  than  in  the  car- 
nivora, and  differ  less  in  form  from  the  incisors  on  the  one  hand, 
and  the  first  molars  on  the  other.  The  molars  again  are  thick 
and  strong,  and  have  comparatively  flat  surfaces,  like  those  of  the 
herbivora;  but,  instead  of  presenting  curvilinear  ridges,  are 
covered  with  more  or  less  conical  eminences,  like  those  of  the  car- 
nivora. In  the  human  subject,  therefore,  the  teeth  are  evidently 
adapted  for  a  mixed  diet,  consisting  of  both  animal  and  vegetable 
food.  Mastication  is  here  as  perfect  as  it  is  in  the  herbivora, 
though  less  prolonged  and  laborious ;  for  the  vegetable  substances 
used  by  man,  as  already  remarked,  are  previously  separated,  to  a 
great  extent,  from  their  impurities,  and  softened  by  cooking,  so 


ON    DIGESTION.  109 

that  they  do  not  require  for  their  mastication  so  extensive  and 
powerful  a  triturating  apparatus.  Finally,  animal  substances  are 
more  completely  masticated  in  the  human  subject  than  they  are  in 
the  carnivora,  and  their  digestion  is  accordingly  completed  with 
greater  rapidity."  ! 

However  much  natural  selection  may  have  rendered  stronger 
the  surviving  species  of  other  animals,  it  has,  in  the  case  of  the 
human  teeth,  proved  injurious  to  the  perfection  of  our  race. 
Artists  have,  unhappily,  taught  us  to  see  loveliness  in  button 
mouths,  bud-like  lips,  round  dimpled  chins,  tiny  pearly  teeth,  and 
to  recognize  aristocracy  in  hatchet  faces.  You  take  up  a  skull  in 
one  of  the  bone-houses  near  old  fields  of  battle  (say  at  Hythe, 
where  Pict  and  Briton,  and  others  besides,  grin  so  grimly  at  us), 
and  you  cannot  enough  admire  the  evenness,  the  firmness,  the 
completeness  of  the  set  of  half-worn,  yet  quite  sound  teeth ;  but 
you  are  fain  to  confess  that  to  have  a  wife,  or  a  son,  or  a  daughter 
with  a  prominent  square  jowl  like  that,  would  be  a  severe  trial  to 
your  aesthetic  feelings.  You  are  incurably  perverted  by  the  me- 
diaeval association  of  moral  purity  and  intellectual  refinement  with 
pitifully  weak  jawbones ;  and  a  big-mouthed  broad-nosed  Helen 
would  never  have  been  the  mother  of  your  children — yet  would 
she  have  saved  you  many  a  dentist's  fee.  Narrow  jaws  can  hold 
but  few  teeth ;  if  the  natural  numbers  come,  some  must  be  ex- 
tracted, or  else  they  crowd^  together,  and  decay  from  pressure; 
and  there  is  no  feature  which  is  so  markedly  hereditary  as  narrow 
jaws ;  as  the  mother  is,  so  is  the  offspring. 

When,  by  the  grinding  machinery  above  described,  the  food  has 
been  reduced  to  a  pulp,  it  is  easily  embraced  by  the  tubular  mus- 
cles of  the  pharynx  and  oesophagus,  and  passed  by  their  steady, 
wavelike  motion  downwards  to  the  stomach ;  the  passage  is 
opened  before  it,  and  its  return  is  prevented  by  the  closing  of  the 
tube  behind  as  it  goes  onwards.  The  sensibility  of  the  cesophagus 
is  so  very  slight,  that  we  do  not,  in  ordinary  circumstances,  feel 
the  morsel  going  down;  but  if  it  is  peculiar  in  shape  and  nature, 
we  become  aware  how  slowly  and  steadily  it  proceeds,  and  ought 
to  proceed.  For  during  this  passage,  much  of  the  sugar  and  solu- 
ble salts,  and  the  watery  part,  is  taken  up  by  absorption,  and  if 

1  Dalton's  Physiology,  chap,  vi,  p.  109. 


110  GENERAL    DIETETICS. 

it  is  hurried  by  bolting  mouthful  after  mouthful  in  rapid  succession, 
scant  justice  is  done  to  the  victuals,  and  a  risk  of  indigestion  is 
incurred.  The  healthy  circulation  of  saliva  in  this  round  is  very 
great ;  we  have  seen  lately  how  many  pints  are  poured  out  daily 
in  the  mouth,  and  of  this  but  little  finds  its  way  to  the  intestines, 
the  rest  being  taken  up  in  the  resophagus  and  stomach,  principally 
in  the  former.  So,  the  importance  of  not  interfering  with  its  due 
action  can  be  easily  understood. 

Once  in  the  stomach,  the  mass  of  food  acquires  a  rotation  from 
the  wavelike  movement  kept  up  by  the  peristaltic  muscles  of  the 
stomach.  Their  alternate  contractions  and  relaxations  press  on 
the  mass,  much  as  the  undulations  of  a  serpent  carry  it  over  the 
ground — only  in  the  latter  case  the  undulating  body  is  free,  in  the 
former  it  is  fixed.  The  surface,  being  the  part  subjected  to  the 
moving  power,  moves  quicker  than  the  centre,  and  thus  the  whole 
contents  of  the  stomach  are  rotated  as  a  uniform  mass,  from  left 
to  right,  and  continually  irrigated  by  the  gastric  juice  along  the 
depending,  lower,  and  larger  part  of  the  sac.  As  it  passes  the 
opening  of  the  pylorus  at  the  other  end,  the  narrowing  of  the  sac 
squeezes  out,  with  a  somewhat  quicker  motion,  such  portion  as  is 
dissolved  into  creamy  chyme,  and  it  oozes  on  into  the  duodenum, 
leaving  the  still  undissolved  substances  to  flow  along  the  shorter 
and  upper  curve  of  the  stomach  back  to  the  starting-point.  Thus, 
a  slow,  rotatory  movement  of  the  whole  mass  is  sustained  till  all 
is  dissolved,  or,  at  least,  so  far  reduced  in  size  as  to  get  through 
the  pylorus. 

The  rotation  seems  to  be  continued  in  the  intestines,  if  one  may 
judge  fairly  of  the  action  of  their  peristaltic  fibres  by  the  move- 
ments seen,  immediately  after  death,  in  the  intestines  of  a  vigor- 
ous animal  slaughtered  for  food.  And  the  biliary  ducts  appear, 
also,  to  have  a  peristaltic  action,  rolling  out  gradually  and  regu- 
lating the  flow  of  bile  into  the  duodenum.  Now,  over  all  these 
involuntary  and  unfelt  but  constant  wavelike  movements,  the 
nervous  system  presides ;  and  they  are,  without  doubt,  seriously 
affected  by  all  that  affects  the  nervous  system,  notably  by  mental 
emotion  and  bodily  exhaustion.  The  oesophagus  is  sometimes  so 
paralyzed  by  a  sudden  shock  during  a  meal,  that  it  does  not  close 
behind  the  victuals  swallowed,  and  they  are  thrown  up  by  a  sort 
of  regurgitation.  Even  some  hours  after  a  meal,  the  arrest  of  the 


ON    DIGESTION.  Ill 

stomach's  action  by  emotion  may  cause  vomiting.  And  many 
instances  arc  on  record  of  a  mental  emotion  so  arresting  the  biliary 
ducts  as  to  produce  jaundice.  The  late  Dr.  Macleod,  of  St. 
George's  Hospital,  used  to  relate  a  scene  which  he  saw  in  his  own 
practice :  a  young  lady  with  distended  abdomen  was  charged  with 
being  privately  married,  and  her  eyes  and  skin  had  got  bright 
yellow  before  he  left  the  room.  And,  in  the  wild  times,  when 
people  really  did  get  into  a  passion  sometimes,  they  are  stated  by 
bystanders  to  have  often  become  jaundiced.  Few  of  ns  have  ever 
seen  an  adult  in  a  rage  of  the  old  sort,  so  that  we  must  not  ques- 
tion the  accuracy  of  the  statement. 

Yriicther  absorption  of  the  dissolved  alimentary  substances  is 
affected  by  similar  causes  is  not  clear.  I  see  no  reason  to  suppose 
that  it  is,  as  endosmosis  is  such  a  purely  physical  act,  that  the 
nervous  system  can  control  it  only  very  indirectly.  But,  as  the 
supply  is  cut  off,  it  cannot,  of  course,  be  active  during  the  preva- 
lence of  such  interferences. 

The  subject  of  the  impediments  to  digestion  arising  out  of  dis- 
ease of  various  kinds,  is  of  too  great  weight  to  be  cited  merely  as 
an  illustration,  and  will  be  considered  more  fitly  in  a  future  part 
of  the  volume.  Here  is  the  place  for  a  few  reflections  on  the 
suitability  of  different  articles  of  food. 

Aliments  may  be  called  digestible  when  they  yield  readily  all 
their  nutritious  particles  to  the  fluids  destined  for  their  reduction 
to  chyme.  It  is  clear  from  what  has  gone  before,  that  a  compara- 
tive estimate  of  their  digestibility  cannot  be  made  merely  by 
reckoning,  as  Dr.  Beaumont  did,  the  duration  of  their  sojourn  in 
the  stomach.  That  well-known  physician  is  familiar  to  all,  from 
having  made  a  series  of  observations  on  a  Canadian  voyageur  who 
had  a  permanent  opening  into  his  stomach,  a  healed  gunshot 
wound.  This  was  easily  looked  into,  and  the  time  consumed  be- 
fore the  victuals  passed  out  noted.  But  the  results,  which  are 
often  taken  as  an  infallible  guide  by  the  dietician,  are  not  truly  in 
accordance  with  what  general  experience  teaches  us  on  this  matter. 
For  example,  salt  tripe  or  pig's  trotters,  by  this  theory,  take  only 
one  third  of  the  time  demanded  by  roast  beef,  the  former  dish 
being  dissolved  in  the  stomach  in  one  hour,  and  the  latter  requir- 
ing three,  while  veal  took  four  hours  and  a  half.  Sour-cnmt 
seemed  to  be  twice  as  digestible  as  soup  made  of  beef  and  vegeta- 


112  GENERAL    DIETETICS. 

bles.  Mutton  was  three  quarters  of  an  hour  longer  in  digesting 
than  beef,  and  so  on.  Green  vegetables,  again,  are  hardly  at  all 
touched  by  the  gastric  juice — are  we  therefore  to  conclude  that 
they  are  useless  ? — surely,  the  general  observation  that  they  are 
very  digestible  by  a  healthy  man  is  more  in  accordance  with  fact. 

I  do  not  lay  much  stress  on  the  objection  to  these  experiments 
arising  out  of  individual  peculiarity  of  constitution ;  for  in  fact 
the  subject  of  observation  was  a  remarkably  robust  man,  little 
affected  by  external  circumstances,  and  able  to  carry  on,  in  spite 
of  the  hole  in  his  side,  the  laborious  duty  of  conducting  timber- 
rafts  down  the  American  rapids. 

In  order  to  give  observations  like  Dr.  Beaumont's  their  full 
value,  they  should  be  corrected  by  a  set  of  similar  tests  conducted 
upon  the  duodenum  and  ilia,  for  which  a  good  opportunity  has 
not  yet  occurred.  Experiments  on  animals  have  been  made,  it  is 
true;  and  they  establish  the  fact  that  the  intestinal  juice  is  of 
great  importance,  and  that  the  pancreas,  if  not  the  liver,  aids  in 
the  solution  of  food  j1  but  the  alimentary  canal,  and  the  habitual 
diet,  of  the  lower  creatures  are  so  different  from  ours,  that  a  com- 
parison of  the  behavior  of  different  articles  of  food  in  their  case, 
affords  no  practical  experience  for  human  dietetics. 

Something  in  the  way  of  a  comparative  estimate  might  be 
made  by  laboratory  experiments  on  the  juices  removed  from  the 
body,  separately  and  mixed.  Pending  advances  in  this  direction, 
the  following  general  conclusions  are,  perhaps,  all  the  rules  our 
knowledge  enables  us  to  lay  down  : 

The  degree  of  Cohesion  has  an  important  influence  upon  digesti- 
bility.— Tough  articles,  incapable  of  being  ground  up  by  the  teeth, 
remain  unused  by  the  alimentary  organs,  while  fluids  and  semi- 
fluids  lead  the  van  of  digestibles.  The  tissues  of  young  vegeta- 
bles and  young  animals  are,  for  this  reason,  more  digestible  than 
those  of  old  specimens  of  the  same  class.  And  emasculated 
beasts,  having 'softer  muscles,  are  better  suited  for  the  table  than 
perfect  males.  It  is  desirable  also  that  the  post-mortem  rigidity, 
which  lasts  several  days  in  some  animals,  should  have  merged  in 
softness  before  the  meat  is  cooked.  But  this  object,  usually  at- 


1  See  the  plates  illustrative  of  Dr.  Dalton's  experiments,  Human  Phys.,  p. 
146. 


ON    DIGESTION.  113 

tained  by  hanging  in  the  larder,  may  be  arrived  at  equally  well 
by  immediate  cooking,  before  the  rigidity  has  set  in.  In  warm 
climates  and  exceptionally  warm  weather,  the  latter  course  is  the 
preferable  of  the  two. 

That  culinary  preparation  is  the  most  efficacious,  which  most 
breaks  up  the  natural  cohesion  of  the  viands.  And  it  may  be 
observed  that  the  force  of  cohesion  acts  in  all  directions ;  and  it  is 
of  no  use  for  a  viand  to  be  laterally  friable,  if  it  remains  in  lon- 
gitudinal strings. 

Fat  interposed  between  the  component  parts  of  food  diminishes  its 
digestibility. — It  is  the  interstitial  layer  of  fat  between  the  bundles 
of  fibres  of  beef  that  makes  it  less  digestible  than  mutton,  and 
that  causes  larded  meats  often  to  disagree. 

Dilation  favors  digestibility. — Yet  it  may  be  carried  too  far. 
Even  water  will  sometimes  run  through  the  alimentary  canal, 
carrying  on  too  rapidly  the  matters  dissolved  in  it.  And  inert 
substances,  such  as  wroody  fibre,  if  mixed  up  in  too  great  quan- 
tity with  food,  dilute  it  so  much  that  the  central  parts  of  the  mass 
do  not  come  at  the  digestive  mucous  membrane.  Gelatin,  proba- 
bly in  the  same  way,  retards  the  digestion  of  food  if  too  concen- 
trated. 

Too  high  a  temperature  retards  digestion. — It  is  not  merely  that 
the  gastric,  and  presumably  the  other  digestive  solvents,  are  de- 
composed by  heat  above  that  of  the  body,  but  the  amount  of  se- 
cretion and  the  muscular  acts  necessary  to  forward  solution  are 
arrested  by  its  local  action.  This  applies  principally  to  starchy 
foods,  which  are  often  taken  hotter  than  at  all  suits  the  salivary 
glands.  Meat  has  time  to  cool  before  it  gets  down  to  the  labora- 
tory prepared  for  it  in  the  stomach. 

The  application  of  these  rules  to  practice  is  not  difficult;  but  it 
is  obviously  impossible  to  compare  articles  of  diet  unless  they  are 
of  a  definite  quality;  and,  therefore,  it  will  be  understood  that 
all  those  spoken  of  are  supposed  to  be  of  the  very  best  sort,  and 
dressed  in  the  way  best  adapted  for  securing  their  virtues. 

Some  years  ago,  I  printed  what  I  called  a  "  Ladder  of  meat- 
diet  for  invalids,"1  which  I  will  repeat  in  a  future  part  of  this 
volume,  when  we  come  to  consider  the  regimen  of  the  sick.  I 

1  The  Indigestions,  p.  101,  3d  edit.,  Philadelphia,  1870. 
8 


114  GENERAL    DIETETICS. 

there  conclude  with  roast  joint  of  mutton,  which  is  the  "promised 
land  "  of  the  convalescent ;  so,  that  dish  may  fairly  here  begin 
the  list,  which  may  form  a  sort  of  skeleton  framework — from  its 
actual  or  possible  position  in  which  may  be  judged  roughly  the 
comparative  time  which  each  article  is  likely  to  require  for  its  di- 
gestion. When  time  and  strength  have  to  be  economized,  or 
where  a  full  quantity  is  required  for  purposes  of  nutrition,  it  is 
wise  to  adhere  to  the  leading  names  on  the  list.  Where  modera- 
tion can  be  calculated  upon,  and  full  leisure  secured,  a  healthy 
man  cannot  be  called  imprudent  for  indulging  his  appetite  for  va- 
riety by  descending  to  the  very  bottom.  Indeed,  to  do  so,  within 
reasonable  bounds,  contributes  to  high  health ;  for  it  is  certain 
that  an  important  element  in  making  the  most  of  food  is  variety. 
It  is  not  enough  to  supply  in  proper  amount  the  proximate  diet- 
etic substance;  both  in  our  own  race  and  in  domestic  animals 
there  is  risk  of  a  falling  off  in  condition  unless  different  substances 
of  the  same  class  are  employed  in  rotation.  The  very  strongest, 
perhaps,  can  bear  uniformity  without  injury,  but  to  the  average 
man  or  beast  it  is  as  finally  noxious  as  it  is  distasteful.  Dr. 
Parkes  suggests  that  the  good  effect  of  variety  is  probably  on 
primary  digestion,  improving  the  appetite  and  so  causing  more 
food  to  be  taken  by  counteracting  the  cloying  result  of  sameness.1 
But  I  think  it  goes  further  than  that,  for  few  can  fail  to  have  no- 
ticed in  their  own  personal  experience,  if  once  the  attention  be 
called  to  it,  how  often  a  most  indigestible  dish,  when  partaken  of 
as  an  occasional  luxury,  has  seemed  to  sit  easy  on  the  stomach, 
and  to  nourish  well  though  its  quantity  has  been  spare.  The 
great  art  is  to  give  it  time  and  space,  and  to  be  moderate. 

Dr.  Parkes  makes  the  further  very  practical  suggestion,  that 
where  variety  of  sort  of  food  is  unattainable,  variety  of  cookery, 
to  a  certain  extent,  fulfils  the  same  object. 

Table  of  Precedence  in  Digestibility  of  some  Articles  of  Animal  Food. 

Sweet-bread,  and  lamb's  trotters. 

Boiled  chicken. 

Venison. 

Lightly  boiled  eggs,  new  toasted  cheese. 

Roast  fowl,  turkey,  partridge,  and  pheasant. 

1  Parkes,  Practical  Hygiene,  p.  186,  4th  edit. 


ON    DIGESTION.  115 

Lamb,  wild  duck. 

Oysters,  periwinkles. 

Omelette  (?),  tripe  (?). 

Boiled  sole,  haddock,  skate,  trout,  perch. 

Tripe  and  chitterlings.1 

Koast  beef. 

Boiled  beef. 

Kump  steak. 

Roast  veal. 

Boiled  veal,  rabbit. 

Salmon,  mackerel,  herring,  pilchard,  sprat. 

Hard-boiled  and  fried  eggs. 

Wood  pigeon,  hare. 

Tame  pigeon,  tame  duck,  goose. 

Fried  fish. 

Roast  and  boiled  pork. 

Heart,  liver,  lights,  milt,  and  kidneys  of  ox,  swine,  and  sheep. 

Lobsters,  shrimps,  prawns. 

Smoked,  dried,  salt,  and  pickled  fish. 

Crab. 

Ripe  old  cheese. 

Caviare. 

The  comparative  digestibility  of  various  vegetable  dishes  is 
easier  to  estimate  than  that  of  animal  food ;  it  is  in  a  direct  ratio 
to  the  facility  with  which  they  are  reducible  into  a  homogeneous 
mass,  by  mechanical  means,  from  their  natural  form.  And  they 
are  more  readily  digested  if  this  reduction  takes  place  through 
chewing  in  the  mouth,  rather  than  by  mashing  in  the  kitchen,  as 
they  in  the  first  way  become  permeated  more  thoroughly  by  the 
saliva.  If,  on  the  score  of  defective  teeth  or  other  reasons,  a  pref- 
erence is  given  to  artificially  broken-up  vegetables,  they  should  be 
retained  in  the  mouth  longer  than  is  required  by  the  mere  prepa- 
ration for  swallowing. 

The  influence  of  the  mind  over  digestion  must  not  be  forgotten. 
"  Bread  eaten  in  sorrow  "  remains  unabsorbed,  and  it  is  not  with- 
out reason  that,  even  in  the  earliest  times  and  among  the  most 
barbarous  tribes,  companionship  during  meals  has  always  been 
sought.  It  is  not  only  painful  reflections  which  disturb  the  di- 
gestion ;  any  concentrated  thought  is  equally  injurious,  and  inju- 
rious in  a  close  proportion  to  the  intellectual  powers  of  the  indi- 

1  The  "  tripe  •'  as  made  in  America  would  seem  from  Dr.  Beaumont's  ac- 
count to  be  more  digestible  than  the  rich  dish  we  prepare  from  it  here. 


116  GENERAL    DIETETICS. 

vidual.  The  only  people  fit  to  feed  alone  are  those  fluttering 
butterflies  whose  intellects  do  not  dispose  them  to  concentrate 
their  thoughts,  and  whose  good  luck  exempts  them  from  the  need 
of  trying.  And  even  these  instinctively  seek  society.  To  the 
brain-worker  and  the  body-worker,  cheerful  distraction  at  meal- 
times is  a  rule  of  imperious  necessity,  the  habitual  neglect  of 
which  entails  chronic  disease  and  the  early  failure  of  vital  powers 
as  a  certain  punishment. 

The  adjuncts  of  family  meals  should  be  studiously  made  as 
agreeable  as  possible.  A  change  of  clothes,  clean  hands,  and 
courteous  manners,  should  not  be  reserved  for  company,  but  en- 
forced as  a  daily  habit.  If  allowed  to  be  omitted,  it  becomes  a 
labor  instead  of  a  matter  of  course.  Table  decking  is  an  elegant 
art,  capable  of  exhibiting  the  good  sense,  as  well  as  the  good 
taste,  of  the  artist,  and  highly  promotive  of  ease  of  mind  in  the 
company,  however  small,  or  however  familiar.  If  flowers  are 
lacking,  there  are  always  leaves  to  be  had,  and  I  have  seen  toad- 
stools with  mosses  and  lichens  so  arranged  as  to  form  a  centre- 
piece that  Cellini  must  have  praised.  I  do  not  see  why  we  should 
not  have  music  and  singing  at  domestic  meals,  as  well  as  at  city 
feasts.  All  are  not  eating  at  once,  and  a  change  of  performers 
might  be  kept  as  long  as  required.  The  cook,  also,  should  be 
encouraged  to  make  the  dishes  which  are  exposed  to  the  eye  as 
pleasant  to  look  at  as  possible,  not  so  much  by  adornment,  which 
is  apt  to  be  vulgar,  as  by  concealing  all  that  is  untidy  and  sugges- 
tive of  painful  idea.  The  forms  of  animals,  in  fact  anything 
which  makes  us  remember  that  the  food  has  been  a  living  animal 
at  all,  should  never  be  conspicuously  displayed,  but  rather  covered 
with  such  vegetable  garnish  as  is  capable  of  harmonizing  with  the 
character  of  the  dish. 

Ease  of  body,  as  well  as  of  mind,  is  requisite  for  complete  di- 
gestion. Muscular  exertion  should  be  avoided  immediately  before 
and  immediately  after  all  substantial  meals.  The  repose  previous 
need  not  be  long ;  a  nap  of  forty  winks,  dressing,  and  washing, 
are  usually  enough  to  prepare  even  an  exhausted  pedestrian  or 
hard  rider  for  a  good  dinner.  The  best  test  of  due  preparation  is 
a  healthy  appetite  without  any  feeling  of  faintness  or  squeam. 
The  rest  after  meals  requires  rather  more  judgment  and  self-con- 
trol. Instinct  induces  us  to  take  it,  but  does  not  tell  us  to  avoid 


ON    DIGESTION.  117 

excess.  Now,  it  is  certain  that  to  a  healthy  person  excess  is  very 
possible.  Sleep,  for  example,  after  dinner  retards  digestion,  and 
allows  the  distended  stomach  to  act  injuriously  on  the  circulation 
of  the  brain.  It  is  proper  only  for  very  aged  persons  or  invalids. 

I  have  heard  it  argued  by  persons  more  ready  at  observing  the 
facts  of  natural  history  than  at  reasoning  upon  them,  or  perhaps 
still  readier  at  finding  an  excuse  for  laziness,  that  dogs  and  other 
carnivorous  animals  naturally  betake  themselves  to  sleep  after  a 
repast.  That  is  true,  but,  then,  it  must  be  remembered,  that  in 
the  wild  state  their  chance  of  a  meal  comes  but  seldom;  they  must 
take  the  food  when  they  can  get  it,  and  to  guard  against  starvation 
overload  their  stomachs.  The  lethargy  which  follows  is  a  neces- 
sity, and  there  is  no  evidence  that  it  prolongs  their  lives.  Those 
breeds  of  dogs  which  live  most  in  the  company  of  man,  and  feed 
on  the  mixed  and  cooked  diet  of  their  masters,  usually  give  up 
the  practice  of  sleeping  after  meals  along  with  their  gluttony,  and 
to  all  appearance  seem  to  suffer  less  frequently  from  indigestion 
than  their  cousins  at  the  kennels,  who  require  very  careful  treat- 
ment to  preserve  their  health. 

The  best  employment  after  a  hearty  meal  is  frivolous  conversa- 
tion, accompanied  by  such  gentle  sauntering  movements  as  are 
encouraged  by  a  well-ventilated  drawing-room  or  garden.  Then 
is  the  time,  also,  for  those  true  games  where  luck  and  skill  are  so 
combined  as  to  have  the  character  of  game  and  not  of  business. 

I  have  ventured  so  far  to  go  beyond  what  might  seem  the  limit 
of  a  dietician's  tether,  because  it  is  upon  these  social  considerations 
that  depends  the  determination  of  the  best  times  of  meals  for 
healthy  persons.  For  the  heaviest  repasts,  those  hours  should  be 
selected  when  we  can  secure  to  the  fullest  extent  leisure  of  mind 
and  body,  and  the  opportunity  of  applying  the  aids  mentioned 
above  as  tending  to  promote  them.  It  is  useless  to  prescribe  the 
times  for  meals,  or  even  their  number,  unless  with  a  regard  to  the 
disposal  of  the  remainder  of  the  day,  whether  that  is  regulated 
by  choice  or  necessity. 

The  intervals  between  meals,  also,  depend  on  the  occupations 
which  fill  them  up.  Sleep  retards  digestion,  and  therefore  a  con- 
siderably longer  period  may  be  allowed  to  elapse  between  the  last 
food  at  night  and  the  first  in  the  morning  than  is  suitable  during 
the  day.  Violent  exercise  of  mind  or  body  also  retards  digestion, 


118  GENERAL    DIETETICS. 

and  therefore,  when  this  is  practiced,  food  is  not  called  for  so  soon 
as  on  a  day  of  rest.  I  have  often  observed  that,  in  spite  of  a 
late  breakfast,  a  keen  appetite  often  comes  on  Sundays  before  one 
o'clock  to  lawyers  and  merchants,  who  on  working  days  do  not 
care  to  eat  till  two  or  three,  nor  even  then.  Whereas,  busy 
medical  men  whose  work  is  more  continuous,  though  less  severe, 
adopt  the  early  Sunday  dinner  hour  only  with  reluctance. 

There  can  hardly  be  any  exceptions  to  the  rule,  that  after  the 
night's  sleep,  and  the  long  fast  which  has  emptied  the  digestive 
organs,  food  should  be  taken  before  any  of  the  material  business 
of  the  day  is  taken  in  hand.  Work  done  before  breakfast  is  more 
tiring,  and,  with  due  deference  to  certain  well-meaning  enthusiasts 
for  early  rising,  is  not  done  so  well  as  after  the  stomach  has  been 
fortified  with  what  it  must  require,  if  in  a  healthy  state.  The 
hour  of  rising  must,  therefore,  regulate  the  hour  of  breakfast.  It 
is  no  proof  of  health  or  vigor  to  forego  it  without  inconvenience, 
nay  rather  the  contrary ;  but  it  is  proof  of  health  and  vigor  to  be 
able  to  lay  in  then  a  solid  foundation  for  the  day's  labor.  The 
natural  appetite  for  food  should  be  fully  and  completely  appeased ; 
and  if  there  is  a  desire  for  meat,  there  is  no  reason  for  declining 
it ;  indeed,  where  mental  work  has  to  be  done,  it  had  better  not 
be  omitted.  For  mere  bodily  toil,  a  breakfast  merely  farinaceous, 
such  as  porridge,  bread,  milk,  and  butter,  is  most  adapted,  to 
which  the  usual  additions  de  luxe  may  be  made  according  to 
choice. 

Not  more  than  five  hours  should  elapse  before  food  is  again 
taken.  To  some  persons,  from  habitual  neglect,  the  appetite  does 
not  arrive  so  soon ;  and  then  if  they  sit  down  to  an  unaccustomed 
luncheon,  they  feel  stupefied  by  it,  and  quote  this  experience  as 
an  evidence  that  a  midday  meal  is  unwholesome  for  them.  The 
stomach  requires  a  gradual  education  after  it  has  got  into  bad 
habits ;  so,  beginning  with  a  biscuit  and  a  little  milk,  the  patient 
should  advance  in  quantity,  till  he  arrives  at  the  amount  which 
is  shown  to  be  the  proper  amount  by  his  sitting  down  to  his  sub- 
sequent dinner  hungry  and  unexhausted.  The  proper  amount 
varies  much  in  different  persons  and  different  circumstances,  and 
the  only  general  description  that  can  be  applied  to  it  is  "  moder- 
ate." 

Instead  of  a  light  intercalary  meal,  some  families  prefer  to  take 


ON    DIGESTION.  119 

a  substantial  high  dinner  in  the  middle  of  the  day.  This  seems 
to  suit  idle  people  and  children,  but  if  hard  work  has  to  be  re- 
sumed immediately  afterwards,  very  frequently  indigestion  is  the 
result.  It  is  the  cause  of  that  form  of  congestive  dyspepsia  to 
which  the  middle  classes  in  Germany  are  extremely  subject,  and 
which  drives  them  instinctively  to  eliminative  mineral  waters,  like 
swallows  to  the  South. 

The  best  time  for  an  adult's  largest  meal  is  when  the  business 
of  the  day  is  done,  say,  somewhere  between  five  and  eight.  If  it 
is  taken  earlier,  there  is  time  to  get  hungry  again  before  bed-time; 
and  if  later,  sleep  comes  too  soon  on  the  top  of  it.  For  light 
eaters  the  later  hours,  for  heavy  eaters  earlier  hours  are  most  suita- 
ble. It  may  be  observed  that  the  court  dinners  of  the  city  compa- 
nies and  the  merry-makings  of  Greenwich  ichthyophagists,  where 
the  guests  meet  to  eat  largely,  are  usually  early. 

It  is  superfluous  for  a  healthy  person,  not  influenced  by  any  of 
the  peculiar  circumstances  which  will  be  hereafter  considered,  to 
devote  special  attention  to  considerations  concerning  the  whole- 
someness  or  digestibility  of  his  dinner.  He  is  apt  to  leave  off 
this  and  leave  off  that,  under  the  impression  that  they  have  once 
disagreed  with  him,  till  his  bill  of  fare  becomes  most  injuriously 
restricted.  Variety  in  diet  is  of  essential  importance  to  health, 
and  a  succession  of  several  imperfect  or  even  unwholesome  kinds 
of  food  is  better  than  a  monotonous  repetition  of  a  perfect  aliment. 
Occasional  feasts  and  occasional  fasts  constitute  the  natural  mode 
of  life  for  an  intellectual  and  social  animal.  This  paragraph  ap- 
plies to  all  meals,  but  I  have  inserted  it  apropos  of  dinner  as  being 
the  principal. 

By  variety  is  implied,  not  a  great  number  of  dishes  at  once, 
which  is  confusing  and  oppressive,  and  destructive  of  the  object 
aimed  at,  but  a  frequent  (why  not  daily  ?)-difference  in  the  princi- 
pal dish,  to  which  the  few  other  accessory  dishes  are  harmonized. 
Some  of  the  most  appetizing  dinners  one  has  ever  eaten  have 
really  consisted  of  one  article,  novel  and  unexpected.  The  famous 
Mrs.  Poyser  sagely  remarked  that  a  man's  stomach  likes  to  be 
surprised,  and  no  surprise  is  possible  if  the  same  monotonous 
superfluity  is  repeated  day  after  day. 

In  the  course  of  the  evening  a  cup  of  tea  seems  to  give  a  fresh 
fillip  to  digestion,  and  supplies  liquid  which  is  required  for  solu- 


120  GENERAL    DIETETICS. 

tion  of  the  viands.  Some  persons  are  afraid  of  its  keeping  them 
awake,  and  will  find  a  good  substitute  in  extempore  lemonade — a 
cup  of  hot  water  poured  on  a  slice  of  lemon,  some  chips  of  the 
rind,  and  a  lump  of  sugar.  But  tea  of  an  afternoon  is  by  no 
means  to  be  recommended.  The  habit  of  taking  it  began  as  a 
sort  of  fashionable  whim  about  a  dozen  years  ago,  but  spread  so 
far  downwards  through  the  middle  classes  that  medical  men 
ought  to  exert  themselves  to  stop  it.  If  the  dinner  hour  is  so  late 
that  too  long  a  time  interposes  between  it  and  luncheon,  let  the 
latter  be  moved  onwards,  and,  if  necessary,  breakfast  also.  For 
the  dilution  and  washing  away  of  the  gastric  secretion  weakens  its 
power  of  digesting  the  subsequent  dinner,  improperly  blunts  the 
appetite,  and  not  unfrequently  generates  flatulence  and  dyspepsia. 
A  biscuit,  and  an  orange  or  an  ice  is  a  much  less  injurious  indul- 
gence at  the  same  hour. 

A  man  in  health  ought  to  be  satisfied  with  three  meals  a  day, 
and  should  educate  his  stomach  to  take  enough  at  them  to  supply 
his  requirements.  The  practice  of  constantly  nibbling  at  odd 
times  induces  a  flow  of  saliva  almost  continuous,  like  that  of  her- 
bivorous animals,  and  neutralizes  the  gastric  juice,  so  that  meat  is 
not  fully  digested. 

The  last  meal  should  be  sufficiently  late  for  the  whole  not  to  be 
absorbed  before  retiring  to  rest.  Going  to  bed  hungry  is  liable  to 
induce  a  habit  of  restlessness  at  night.  If  business  or  pleasure 
keep  you  up  much  longer  than  usual,  it  is  better  to  take  a  light 
farinaceous  supper,  which,  in  this  case,  induces  sleep.  This,  how- 
ever, is  a  very  different  thing  from  sleep  in  a  state  of  repletion, 
which  (as  was  before  observed)  disturbs  the  circulation  in  the 
brain,  producing  painful  dreams,  unrefreshing  rest,  and  feverish- 
ness. 

An  average  adult  may  consider  that  he  is  taking  enough  to 
supply  the  ordinary  requirements  of  healthy  activity,  if  he  eats  in 
twenty-four  hours  the  equivalents  of  a  pound  of  meat  and  two 
pounds  of  bread.  The  English  soldier,  on  home  service,  receives 
from  government  f  Ib.  of  meat  and  1  Ib.  of  bread,  and  he  buys 
about  £  Ib.  additional  bread  and  1  Ib.,  or  so,  of  other  vegetable 
food.1  Dr.  Parkes  calculates  that  this  quantity  of  nitrogenous  ali- 

1  Parkes,  Practical  Hygiene  for  Medical  Officers  of  the  Army,  p.  523. 


ON    DIGESTION.  12i 

merit  is  somewhat  deficient  for  the  maintenance  of  high  vigor,  so 
that  I  have  ventured  to  add  J  Ib.  of  animal  food,  reducing  by  a 
few  ounces  the  supply  of  vegetables. 

The  nearer  a  man  approximates  to  this  allowance  the  better,  if 
he  has  no  individual  peculiarities  of  size,  temperament,  occupa- 
tion, climate,  or  state  of  health  to  allow  for.  To  all  but  excep- 
tional cases,  anything  beyond  this  is  excess — not  hurtful  necessa- 
rily, perhaps  even  beneficial  as  an  occasional  change,  but  still  an 
excess.  To  continue  such  excess  as  a  daily  habit,  puts  a  person 
in  a  position  more  prone  to  ill  health  than  he  would  be  natu- 
rally. To  err  by  defect  is  equally  injurious  if  persisted  in;  but 
it  has  this  advantage,  that  it  oftener  obtains  a  compensation 
which  to  a  considerable  extent  rectifies  the  balance.  Thus,  the 
soldier  at  home,  above  quoted  in  illustration,  gets  frequent  little 
treats,  partly  out  of  his  own  and  partly  out  of  others'  pockets, 
which  fill  up  the  corners  left  by  the  government  ration.  And, 
perhaps,  the  most  perfect  diet  is  one  just  within  the  limit  pro- 
posed, with  an  occasional  transgression  as  a  change. 

It  is  possible,  certainly,  for  a  high  liver  to  make  an  equivalent 
change  by  abstinence ;  and  if  he  is  lucky  enough  to  be  ill  and  go 
to  a  doctor,  he  is  perhaps  advised  to  do  so ;  but  I  have  never  yet 
known  one  to  fast  voluntarily  as  a  preservative  to  health,  though 
he  must  have  often  felt  the  beneficial  effects  of  its  being  forced 
upon  him.  It  is  forced  upon  him,  sometimes,  as  a  direct  conse- 
quence of  the  habit  of  overeating;  a  surfeit  of  accumulation  comes 
on,  or  he  brings  it  on  by  going  a  little  further  than  usual,  and 
then  nausea  and  loss  of  appetite  perform  the  good  office  of  mak- 
ing a  change  by  cutting  off  the  supplies.  Unless  relieved  in  this 
way,  the  high  liver  gets  torpid  and  stupid  by  day,  restless  by 
night,  there  is  a  sluggish  circulation  in  the  veins  from  the  over- 
loading of  the  blood  with  useless  material,  there  are  congestions 
and  engorgements  of  the  internal  organs,  and  dark  dirty  discolora-  ( 
tions  of  the  skin,  thick  urine,  flying  unaccountable  pains,  neural- 
gia, rheumatism,  gout,  obesity. 

The  evils  of  too  great  restriction  of  food  will  be  considered  in  a 
future  chapter,  when  we  come  to  the  subject  of  poverty  as  a  modi- 
fying circumstance  in  dietetics. 


122  GENERAL    DIETETICS. 


CHAPTER  V. 
i 

NUTRITION. 

WITH  the  passage  of  the  liquefied  alimentary  substances  through 
the  mucous  membrane  lining  the  tube,  digestion,  strictly  so-called, 
ends.  Anything  which  afterwards  occurs  to  the  incoming  matter 
may  more  properly  be  classed  writh  nutrition. 

Prominent  among  the  needful  changes  in  the  material  for  build- 
ing up  the  tissues,  stands  that  which  takes  place  in  the  liver. 
The  biliary  secretion  from  this  organ  has  been  spoken  of  in  the 
previous  chapter  as  taking  a  part,  though  not  a  leading  part,  in 
the  solution  of  fat  in  water,  as  staying  the  too  rapid  decomposition 
of  albuminous  food  and  excretory  matter,  and  as  supplying  some 
of  the  liquid  vehicle  in  which  the  aliment  is  conveyed  through 
the  walls  of  the  digestive  tube.  In  all  these  the  liver  is  subordi- 
nate, and  its  place  may  be  readily  supplied.  But  the  anaemic  de- 
generation of  the  blood,  the  gradual  pining  emaciation,  and  ulcer- 
ation  of  the  tissues,  and  finally  death,  which  follow  its  suppression 
— all  of  wrhich  point  to  some  deficiency  of  assimilative  capacity 
and  not  merely  to  the  stoppage  of  an  excretion — show  that  it  per- 
forms in  the  circle  of  life  some  special  duty  which  cannot  be  spared 
or  replaced  by  another  gland.  The  blood  going  into  the  liver  is 
altered  before  it  comes  out  of  the  liver  much  further  than  is  in- 
volved in  the  mere  formation  of  bile. 

During  the  last  thirty  years,  the  changes,  necessary  to  life, 
wrought  on  the  blood  by  the  liver  have  engaged  a  large  share  of 
the  attention  of  physiologists.  I  have  been  comparing  the  account 
which  I  printed  in  18561  of  what  had  been  done  up  to  that  time 
with  those  of  the  present  day,  and  I  find  a  progressive  advance 
towrards  the  light,  which  seems  to  promise  our  sons  not  only  in- 
teresting, but  practical  knowledge.  It  was  then  established  that 
"  a  copious  amount  of  sugar  is  formed  in  the  cells,  and  is  forwarded 
into  the  hepatic  vein,  but  not  into  the  bile-ducts,"  and  "  that  the 
sugar  is  formed  in  consequence  of  taking  food."2  It  has  been 

1  Digestion  and  its  Derangements,  chapter  vii.  2  Ib.,  p.  160. 


NUTRITION.  123 

now  ascertained  that  it  is  not  only  an  immediate  consequence, 
that  the  sugar  does  not  pass  from  the  food  into  the  liver,  but  that 
the  sugar-making  in  the  cells  of  the  gland  continues  for  a  long 
time  after  the  alimentary  canal  is  emptied.  It  appears,  moreover, 
that  the  sugar,  though  more  copious  even  than  had  been  supposed,  is 
a  very  transitory  stage  in  the  circle  of  chemical  changes.  It  is  so 
momentary  that  it  can  be  made  evident  only  by  an  artificial  arrest, 
just  as  electrical  action  in  the  earth,  though  so  vast  in  its  results, 
touches  our  senses  only  through  the  partial  derangement  which 
shows  itself  in  the  lightning's  flash. 

But  let  it  not  be  reckoned  as  of  small  moment  because  of  its 
latency.  It  is  an  observation  as  old  as  Thucydides,  that  the  in- 
fluential forces  in  the  world  are  the  most  active  when  most  un- 
noticed ;  for,  indeed,  perturbed  crises  are  usually  the  results  of 
their  disturbance.  We  may  see  in  diabetes  the  serious  evil  of  the 
further  conversion  of  the  sugar  being  interfered  with,  and  of  its 
remaining  in  the  blood  only  to  run  off  by  the  urine,  and  we  can 
hardly  doubt  that  the  breach  of  a  previous  link  in  the  chain,  the 
formation  of  sugar,  may  cause  equal  discomfort  and  explain  at  a 
future  time  some  obscure  morbid  states. 

Those  who  take  delight  in  the  glimmering  through  the  mist  of 
future  light,  will  find  much  to  interest  them  in  Dr.  Dalton's  sketch 
of  this  subject,  and  the  details  of  the  experiments  repeated  by  him- 
self, with  ingenious  precautions  to  avoid  error,  in  the  ninth  chap- 
ter of  his  "  Human  Physiology." 

That  the  spleen  and  lymphatic  glands  take  also  a  part  in  nutri- 
tion, or  blood-making,  is  pretty  clear,  but  which  part  is  entirely 
unknown. 

The  defectiveness  of  our  information  about  the  stages  and 
machinery  of  nutrition  does  not,  however,  prevent  us  from  having 
a  clue  to  a  good  deal  of  practical  knowledge  of  the  comparative 
NUTRITIOUSNESS,  for  different  purposes,  of  different  kinds  of  diet. 

By  nutrition,  two  ends  have  to  be  accomplished,  the  growth  or 
repair  of  the  body,  and  the  production  of  motion  or  force.  The 
first  indication  is  more  or  less  fulfilled  in  proportion  to  the  quan- 
tity of  digestible  nitrogenous  material,  the  latter  in  proportion  to 
the  quantity  of  digestible  carbohydrates  which  the  aliments  con- 
tain. It  is  very  clear  that  the  digestibility  must  be  insisted  upon, 
otherwise  we  should  make  serious  mistakes  in  our  valuations  of 


124  GENERAL    DIETETICS. 

food.  For  instance,  according  to  the  well-known  table  of  M. 
Payen,  a  pound  of  chestnuts  and  a  pound  of  milk  contain  very 
nearly  the  same  quantity  of  nitrogen ;  yet,  to  expect  that  a  baby 
would  grow  as  well  upon  one  as  the  other  would  be  criminal  folly. 
When,  then,  circumstances  require  us  to  foster  growth,  to  increase 
the  vigor  of  the  muscles  and  nerves  for  short  temporary  exertions, 
to  replace  preternatural  wear  and  tear,  meat  is  valuable  in  the 
direct  ratio  of  its  solubility  in  the  stomach.  When  the  regular 
performance  of  a  daily  round  of  moderate  exertion  alone  has  to  be 
provided  for,  carbohydrates  in  the  form  of  farinaceous  and  oleag- 
inous food  may  with  advantage  constitute  the  chief  of  the  diet. 
So  that  before  giving  any  general  rules  for  the  selection  of  a  diet- 
ary which  will  best  perform  its  duties,  it  will  be  needful  to  review 
the  special  circumstances  for  which  it  is  required,  which  I  propose 
to  do  in  respect  of  normal  conditions  in  the  second  part,  and  in 
respect  of  morbid  conditions  in  the  third  part  of  this  volume. 


SPECIAL  DIETETICS  OF  HEALTH. 


CHAPTER  I. 

REGIMEN   OF   INFANCY  AND    MOTHERHOOD. 

IT  may  be  presumed  no  Englishman  doubts  that  the  best  food 
for  a  new-born  infant  is  a  mother's  milk.1  Even  deviations  from 
the  normal  condition  of  the  general  system,  or  of  the  breast,  should 
not  be  allowed  too  readily  to  deter  a  mother  from  suckling,  till 
there  is  evidence  that  the  secretion  is  disagreeing  with  the  child. 
Unless  diarrhaaa  or  thrush  occur,  it  may  be  taken  for  granted  that 
proper  nutriment  is  afforded,  and  if  proper  nutriment  is  afforded, 
we  may  be  sure  a  woman's  health  is  not  affected  by  the  inconve- 
niences which  she  may  be  enduring. 

I  have  known  a  woman,  unable  to  feed  herself  from  severe 
rheumatic  fever,  have  her  child  held  to  her  breast  and  be  nour- 
ished only  from  thence,  without  any  harm  following.  And  in 
several  instances  slight  inflammation  of  the  breast  has  seemed  to 
be  benefited  by  the  flow  of  milk  induced  by  suckling.  Indeed,  I 
have  once  seen  a  breast  with  an  abscess  in  it  supply  healthy  nutri- 


1  Strange  to  say  the  opinion  is  not  universal.  Dr.  Brouzet  (Sur  I'^duca- 
tion  Me'dicinale  des  Enfants,  i,  p.  165)  expresses  a  wish  that  the  state  should 
interfere  and  prevent  mothers  from  suckling  their  children,  lest  they  should 
communicate  disease  and  vice  !  A  still  more  determined  pessimist  was  the 
famous  chemist  Van  Helmont,  who  thought  life  is  reduced  to  its  present 
shortness  by  our  instinctive  infantile  propensity,  and  proposed  to  substitute 
bread  boiled  in  beer  and  honey  for  milk,  which  he  calls  "  brute's  food  "  (in 
the  chapter  "  Infantis  nutritio  ad  vitam  longam)." 


126  SPECIAL    DIETETICS    OF    HEALTH. 

ment  to  a  child,  the  mother  feeling  sure  that  the  abscess  did  not 
communicate  with  the  lacteal  tubes.  I  fancy  no  medical  man 
would  sanction  a  persistence  in  the  latter  risk,  but  still  it  were  to 
be  wished  that  our  accoucheurs  would  be  somewhat  less  hasty  than 
they  generally  are  in  debarring  mothers  from  suckling  on  slight 
grounds.  A  certain  injustice  is  inflicted  on  the  child,  and  prob- 
lematical benefit  conferred  on  the  parent. 

During  the  months  of  suckling  it  should  be  the  object  of  the 
mother  first  to  provide  herself  with  an  appetite,  and  secondly,  to 
provide  herself  with  proper  food.  The  appetite  often  fails  simply 
from  want  of  fresh  air,  especially  in  those  who  are  used  to  enjoy 
it,  the  remedy  for  which  state  of  things  is  sufficiently  obvious. 
Sometimes  the  disrelish  for  food  is  a  symptom  of  the  exhaustion 
induced  by  the  labor,  and  then  small  doses  of  sal  volatile  or  a 
light  bitter,  such  as  gentian,  will  remove  it.  Sometimes  it  is  a 
direct  gastric  anaemia,  arising  from  going  too  long  without  food. 
The  patient  should  eat  directly  she  begins  to  feel  hungry,  and  not 
wait  to  feel  very  hungry.  But  at  the  same  time  she  should  be 
careful  not  to  overload  the  stomach  ;  in  fact,  though  she  eats  often, 
she  should  not  eat  more  than  when  in  ordinary  healthy  exercise. 
A  great  mistake  is  often  made  by  endeavoring  to  supply  the  wants 
of  strength  and  appetite  by  an  extra  supply  of  wine  or  malt  liquor. 
The  nurse  should  never  take  more  than  she  is  accustomed  to ;  if 
she  does,  it  makes  her  eat  less  and  digest  less,  though  she  does  not 
feel  the  debility  which  is  the  consequence  of  the  innutrition.  Beer 
increases  the  quantity  of  the  milk,  just  as  it  increases  the  quantity 
of  the  urine,  but  it  also  renders  it  thin  and  watery  in  the  one  case 
as  in  the  other.  Indeed  less  than  she  is  accustomed  to  is  the  more 
rational  rule  of  diet,  for  the  happy  peaceful  circumstances  of  her 
situation  usually  exempt  her  from  the  mental  wear  and  tear,  and 
the  exhaustions  of  the  nervous  system  incidental  to  social  life, 
which  it  is  the  special  purpose  of  alcohol  to  compensate. 

The  most  proper  food  is  cow's  milk,  fresh  and  unskimmed.  It 
can  be  taken  at  all  times,  in  a  great  variety  of  forms,  and  nobody 
has  ever  been  known  to  take  too  much.  If  it  turns  sour,  lime- 
water  mixed  with  it  not  only  corrects  its  acescence,  but  also  supplies 
a  valuable  aid  to  the  growing  bones  of  the  infant.  In  the  solid 
dietary  again,  milk  may  fairly  be  taken  as  the  type  of  the  due 


INFANCY    AND    MOTHERHOOD.  127 

admixture  of  alimentary  principles,  because  not  individual  growth, 
not  the  production  of  force,  but  the  secretion  of  that  very  sub- 
stance is  the  object  of  the  selection  of  diet.  So  that  we  cannot  do 
better  than  take  the  proportions  of  nitrogenous,  carbonaceous,  and 
aqueous  constituents  of  the  lacteal  secretion  as  a  guide  to  the  pro- 
portions of  these  principles  in  the  diet  of  nursing  mothers.  Anal- 
yses of  milk  are  to  be  found  in  all  physiological  works,  and  if  it 
be  reckoned  roughly  that  in  food  as  presented  for  our  consump- 
tion, there  is  50  per  cent,  of  combined  water,  I  think  it  will  be 
found  that  the  following  scale  of  diet  corresponds  pretty  closely  to 
the  proportion  of  the  several  constituents  there  enumerated. 

Supposing  the  full  diet  to  consist  of  three  pounds  of  solid  food, 
that  will  require  six  pints  extra  of  uncombined  aqueous  fluid  to 
make  it  as  fluid  as  milk.  And  the  three  pounds  of  solid  food 
should  consist  of 

14J  oz.  of  meat, 

13  oz.  of  fat,  butter,  sugar, 

20  oz.  of  farinaceous  food  and  vegetables, 

^  an  oz.  of  salt,  lime,  etc. 

Small  women  and  small  eaters,  especially  if  they  have  small 
children  to  bring  up,  will  require  less;  but  let  the  reduction  be 
proportionate  in  each  of  the  several  classes  of  alimentary  sub- 
stances. And  at  first  from  the  exhaustion  of  parturition,  from  the 
want  of  exercise  and  of  fresh  air,  the  appetite  turns  against  meat. 
Let  then  milk,  especially  boiled  milk  with  arrowroot  or  the  like, 
chicken  broth,  egg-custards,  fill  up  the  deficiency.  Only  insist 
that  enough  is  taken. 

The  observations  by  Dr.  Barker,  of  New  York,  on  this  subject 
are  so  much  to  the  point  that  I  cannot  forbear  quoting  them.  He 
says,  "Give  the  puerperal  woman  as  good  nutritious  food  as  she 
has  an  appetite  for,  and  can  easily  digest  and  assimilate.  You 
will  at  first  find  many  nurses  who  will  not  accept  these  views,  and 
they  may  fail  to  carry  out  your  directions  in  this  particular;  but  my 
experience  has  been  that  after  a  time  the  intelligent  ones  become 
enthusiastic  converts  to  this  course.  .  .  .  Your  patients  rest 
and  sleep  better,  and  their  functions  are  established  with  less  dis- 
turbance than  they  would  be  with  a  spare  or  insufficient  diet. 


128  SPECIAL    DIETETICS    OF    HEALTH. 

Since  I  have  adopted  this  measure  with  my  puerperal  women, 
am  very  sure  I  have  much  less  frequently  met  with  those  annoj 
ing  and  troublesome  nervous  phenomena  that  so  commonly  folio1 
parturition,  as  the  nervous  system  is  then  apt  to  be  in  a  conditio 
of  exalted  susceptibility.  The  function  of  lactation  is  thus  ger 
erally  established  without  that  disturbance  of  the  system  calle 
milk  fever,  formerly  so  common." 1 

It  may  be  noticed  that  the  Professor  says  nothing  about  wir 
and  malt  liquors.  They  are  conspicuous  by  their  absence  in  h 
dietary.  And  in  truth  the  less  a  nursing  mother  takes  of  thei 
the  better,  so  that  her  temper  and  digestion  do  not  obviously  suffi 
from  the  restriction. 

The  child  should  be  put  to  the  mother's  breast  as  soon  as  si 
wakes  from  her  first  sound  sleep  after  its  birth.  The  waiting  fc 
three  or  four  days  is  an  old-fashioned  relic  of  the  days  of  dru£ 
ging,  when  it  was  considered  wrong  that  the  young  bowels  shoul 
be  relaxed  by  the  colostrum  of  the  first  milk,  but  right  that  the 
should  be  griped  with  castor-oil.  Not  to  use  the  first  milk 
wasteful  and  injurious.  The  best  substitute  for  it  is  cow's  mil 
diluted  and  sweetened  as  hereinafter  described. 

The  education  of  the  infant  must  begin  immediately  after  birtl 
In  the  first  place  it  has  to  be  taught  to  suck,  for  which  ever 
monthly  nurse  has  her  own  device,  and  will  only  laugh  at  an 
male  who  should  presume  to  interfere.  Next  it  has  to  be  taugl 
not  to  be  always  sucking,  whenever  the  whim  takes  it  or  th 
mother  comes  in  sight.  Regular  definite  times,  the  intervals  b< 
tween  which  are  gradually  lengthened  as  the  child's  strength  an 
growth  allow,  give  a  rest  both  to  the  stomach  of  the  receiver  an 
the  breast  of  the  giver,  which  conduces  to  the  due  digestion  of  th 
nourishment.  As  a  general  rule  the  daily  allowance  of  milk  r< 
quired  by  a  healthy  infant  is  on  the  first  day  very  small  indeed 
on  the  second  day  it  takes  about  a  quarter  of  a  pint ;  on  the  thir 
day  two-thirds  of  a  pint ;  on  the  fourth  or  fifth  day  it  will  cOr 
sume  a  full  pint.  And  this  quantity  augments  gradually  till  b 
the  sixth  month  you  must  not  calculate  on  less  than  two  pinl 

1  "The  Puerperal  Diseases,"  Clinical  Lectures  delivered  at  Bellevue  Ho: 
pital,  by  Fordyce  Barker,  M.D.,  p.  27. 


INFANCY  AND  MOTHERHOOD.  129 

being  wanted.  The  distribution  should  be  in  an  inverse  ratio  to 
the  quantity.  During  the  first  two  months  the  child  should  have 
the  breast  eight  or  nine  times  daily,  if  the  quantity  yielded  is 
small,  and  six  or  seven  times  if  it  is  large.  After  that  a  gradual 
reduction  may  be  begun,  which  before  weaning  should  have  ar- 
rived at  the  number  of  four  meals  daily,  which  is  the  most  proper 
for  the  digestion  of  mixed  diet. 

If  a  mother,  with  or  without  reasonable  cause,  deputes  her 
duties  to  a  wet  nurse,  she  ought  thoroughly  to  understand  that 
the  expedient  is  not  without  drawbacks.  All  the  best  accoucheurs 
agree  that  in  choosing  a  woman  for  the  office,  observation  of  the 
figure,  the  complexion,  the  color,  the  teeth,  or  even  the  shape  and 
development  of  the  breasts,  and  the  analysis  of  their  secretion,  are 
all  unimportant  compared  with  a  knowledge  of  the  regularity  of 
the  catamcnia.  In  this  respect,  it  stands  to  reason  we  must  take 
the  applicant's  own  character  of  herself,  a  serious  temptation  to 
dishonesty.  An  unmarried  woman  may  not  improbably  have  a 
concealed  constitutional  taint  which  is  communicable  through  the 
milk,  and  at  the  best  is  an  unpleasant  inmate  in  the  family.  A 
poor  married  woman,  however  respectable,  is  removed  from  a  starv- 
ing home  to  sudden  abundance,  and  invariably  overeats  herself, 
and  it  is  fortunate  if  she  does  not  overdrink  herself  too.  She 
pines  and  grows  anxious  about  her  own  child  if  it  is  alive,  and 
insists  upon  having  her  troublesome  husband  to  see  her  openly  or 
secretly,  on  the  pretence  (a  fallacious  one)  that  his  visit  increases 
the  flow  of  milk.  Moreover,  a  rich  mother  cannot  but  feel  some 
compunction  in  purchasing  for  her  own  offspring  what  is  stolen 
from  another,  who  is  sometimes  seriously  affected  by  the  fraud, 
and  retires  disgusted  from  this  false  world. 

At  all  events,  a  trial  ought  to  be  first  made,  under  the  snperin^ 
tendence  of  a  medical  man,  of  fresh  cow's  milk  or  goat's  milk,  and 
of  Swiss  condensed  milk. 

Cow's  milk  should  at  first  be  mixed  with  half  its  bulk  of  soft, 
pure,  tepid  water,  in  each  pint  of  which  has  been  suspended  a 
drachm  of  "  sugar  of  milk  "  (which  is  procurable  at  any  chemist's, 
being  used  for  grinding  up  powders),  and  two  grains  of  phosphate 
of  lime  finely  powdered.  If  the  milk  has  been  partially  skimmed, 
as  is  often  the  case  in  cities,  then  a  good  tablespoonful  of  cream. 

9 


130  SPECIAL    DIETETICS    OF    HEALTH. 

should  be  added  to  each  pint,  to  make  the  mixture  equal  to  human. 
If  it  has  not  been  skimmed,  a  couple  of  teaspoonfuls  of  cream  is 
sufficient.1 

The  advantage  of  using  goat's  milk,  is  that  the  animal  can  be 
brought  up  to  the  very  nursery,  even  in  cities,  and  will  supply 
nourishment  directly  to  its  little  master's  lips  if  called  upon. 
Children  do  not  seem  to  dislike  the  peculiar  taste. 

Swiss  milk  has  been  already  alluded  to  in  the  second  chapter  of 
the  first  part  (p.  65).  No  inconvenience  has  as  yet  been  proved 
to  arise  from  its  use,  but,  at  the  same  time,  no  superiority  to  fresh 
cow's  milk  has  been  confirmed.  As  it  is  already  sweetened  in  the 
preparation,  no  additional  sugar  is  required,  but  care  must  be 
taken  to  dilute  it  sufficiently  to  make  it  resemble  not  ordinary 
milk,  but  milk  and  water. 

Laputa  never  devised  anything  more  preposterous  than  "  Lie- 
big's  food  for  infants."  It  is  composed  of  malt  flour,  wheaten 
flour,  bicarbonate  of  potass,  water,  and  cow's  milk,  and  the  fol- 
lowing is  recommended  as  the  simplest  mode  of  cooking  it : 

Take  of  wheaten  flour,  £  oz. 

Malt  flour,  £  oz. 

Bicarbonate  of  potass,  1\  grs. 

"Water,  £  oz. 

Mix  well,  and  add  of  cow's  milk,  5  oz. 

Warm  the  mixture,  constantly  stirred,  over  a  very  slow  fire  till  it  gets  thick. 
Then  remove  the  vessel  from  the  fire,  stir  again  for  five  minutes,  put  it  back 
on  the  fire,  take  it  off  as  soon  as  it  gets  thick,  and  finally  let  it  boil  well.  Be- 
fore use,  strain  through  a  muslin  sieve. 

The  object  of  all  this  is  to  convert  the  starch  of  the  flour  into 
dextrin  and  sugar,  and  to  elaborate  a  product  which  after  all  is 

1  In  the  above  recipe  household  measurements  are  used  as  the  nearest  pos- 
sible approximation  to  the  following  formula  : 

Whole  cow's  milk, 600  parts. 

Cream, 13      " 

Sugar  of  milk, 15      " 

Phosphate  of  lime,     .......  1£    " 

Water, 339£    " 

1000 
:(Dict.  Encycl.  des  Sciences  Med.,  art.  "  Lait,"  1868.) 


INFANCY  AND  MOTHERHOOD.  131 

not  nearly  so  like  the  natural  sustenance  as  may  be  made  with 
cow's  milk,  water,  and  a  little  additional  sugar  of  milk.  It  is 
needless  to  say  what  a  number  of  unnecessary  risks  are  incurred 
of  some  one  of  the  numerous  articles  employed  being  adulterated, 
of  inaccurate  measurement,  of  dirt,  and  of  careless  preparation  by 
tired  servants,  who,  it  will  be  observed,  have  to  keep  the  fire  low 
for  the  first  part  of  the  process,  and  then  to  coal  it  up,  making  no 
small  smoke,  for  the  final  boil.  Sensible  parents  will  be  content 
to  leave  the  recipe  for  some  coming  race  who  may  prefer  art  to 
nature. 

It  is  advisable  to  nourish  the  infant  directly  from  the  breast; 
and  where  this  cannot  be  done,  as  soon  as  possible  after  the  milk 
is  drawn.  Our  senses  tell  us  of  a  peculiar  aroma  given  off  by 
fresh  milk  which  quickly  exhales,  and  appearances  seem  to  war- 
rant the  conclusion  that  this  contributes  to  soothe  the  sensitive 
nervous  system  of  the  suckling,  and  so  assists  digestion. 

The  best  diet  for  an  infant  during  the  first  six  months,  is  milk 
alone.  It  is  true,  man  is  a  tough  animal,  and  can  stand  with  im- 
punity much  rough  usage,  and  therefore  a  vigorous  baby  often 
seems  none  the  worse  for  a  certain  quantity  of  farinaceous  food ; 
but  the  first  appearance  of  flatulence,  gripes,  screaming,  ill  temper, 
or  other  ways  infants  have  of  complaining  of  dyspepsia,  should 
make  the  nurse  desist  from  these  attempts  to  hurry  on  natural  de- 
velopment. 

It  is  only  when  the  coming  teeth  are  on  their  road  to  the  front  J 
that  the  parotid  glands  secrete  sufficient  saliva  to  digest  farinace- 
Lous  food.  When  dribbling  begins,  then  is  the  time  to  begin  with 
the  various  preparations  of  these  substances  bountifully  supplied 
by  nature  and  art.  Till  then,  anything  but  milk  given  to  a 
healthy  baby  must  be  tentative,  and  considered  in  the  light  of  a 
means  of  education  to  its  future  dietary,  and  must  not  take  the 
place  of  milk. 

Among  the  various  means  of  education,  I  would  select  as  most 
generally  applicable  broth  or  beef  tea,  at  first  pure  and  then  thick- 
ened with  a  little  tapioca  or  arrowroot.  Chicken  soup,  made 
with  a  little  cream  and  sugar,  serves  as  a  change.  Baked  flour, 
biscuit  powder,  and  tops  and  bottoms  should  all  have  their  turn ; 
in  fact,  change  is  necessary,  or  the  child  is  apt  to  get  too  fond  of 


132  SPECIAL    DIETETICS    OF    HEALTH. 

its  soup,  and  to  neglect  the  really  essential  nutriment  of  milk,  and 
to  wean  itself  prematurely. 

The  consequences  of  premature  weaning  are  most  disastrous,  but 
insidious.  The  child  continues  to  present  the  external  aspect  of 
health,  its  muscles  are  strong  and  elastic,  but  the  bones  do  not 
grow  in  equal  proportion.  It  is  active  and  anxious  to  walk,  but 
the  limbs  give  way  and  become  distorted.  If  it  is  ill  enough  to 
be  taken  to  a  medical  man,  he  calls  the  condition  "rickets,"  but 
there  are  crowds  of  poor  creatures  affected  in  this  way  whose  pa- 
rents refuse  to  see  that  anything  is  wrong  till  the  malady  has  gone 
too  far  for  cure.  The  suspicion  that  rickets  was  due  to  this  cause 
has  long  been  prevalent  in  the  profession,  but  it  is  to  M.  Jules 
Guerin  that  we  owe  the  proof  derived  from  direct  experiment. 
This  pathologist  found  not  only  that  rickety  children  had  almost 
invariably  been  prematurely  weaned,  but  that  the  disease  was  capa- 
ble of  artificial  and  intentional  induction.  He  took  young  puppies 
and  young  pigs,  specimens  respectively  of  carnivorous  and  herbiv- 
orous animals,  and  he  produced  a  rickety  softening  of  the  bones 
of  each  by  removing  them  early  from  the  mother,  and  giving  the 
one  set  meat  and  the  other  set  vegetables  before  the  natural  period. 
Professor  Trousseau  has  backed  the  deductions  of  M.  Guerin  with 
his  valuable  imprimatur. 

The  time  for  weaning  should  be  fixed,  partly  by  the  almanac, 
partly  by  the  growth  of  the  teeth.  The  troubles  to  which  chil- 
dren are  liable  at  this  crisis  are  usually  gastric,  such  as  are  induced 
by  hot  weather ;  so  that  in  summer  it  should  be  postponed,  and 
in  winter  hurried  forward.  The  first  group  of  teeth  nine  times 
out  often  consist  of  the  lower  central  front  teeth,  which  excite  no 
wonder  in  any  but  very  young  parents  by  appearing  any  time 
during  the  sixth  and  seventh  month.  The  mother  may  then 
begin  to  diminish  the  number  of  suckling  times ;  and  by  a  month 
she  can  have  reduced  them  to  twice  a  day,  so  as  to  be  ready  when 
the  second  group  makes  its  way  through  the  upper  front  gums  to 
cut  off  the  supply  altogether.  The  third  group,  the  lateral  incis- 
ives  and  first  grinders,  usually  after  the  first  anniversary  of  birth, 
give  notice  that  solid  food  can  be  chewed.  But  I  think  it  is  pru- 
dent to  let  milk,  though  not  mother's  milk,  form  a  considerable 
portion  of  the  diet  till  the  eye-teeth  are  cut,  which  seldom  occurs 


INFANCY  AND  MOTHERHOOD.          .  133 

till  the  eighteenth  or  twentieth  mouth.  At  this  period  even  very 
strong  children  are  liable  to  diarrhoea,  convulsions,  irritation  of 
the  brain,  rashes,  and  febrile  catarrhs.  In  these  cases  the  resump- 
tion of  complete  milk  diet  is  advisable,  and  sometimes  a  child's 
life  has  been  saved  by  its  reapplication  to  the  breast.  Now  these 
means  are  the  most  readily  feasible  when  the  patient  is  accustomed 
to  milk ;  indeed,  if  he  be  not  so,  the  latter  expedient  is  hardly 
possible. 


134  SPECIAL    DIETETICS    OF    HEALTH. 


CHAPTER  IT. 

REGIMEN  OF  CHILDHOOD  AND  YOUTH. 

THE  diet  of  childhood  requires  from  its  rational  guardians  as 
much  attention  as  that  of  infancy.  The  passions  at  this  age  over- 
power the  instinct,  and  reason  has  not  yet  asserted  its  throne. 
Children  should  have  four  meals  a  day,  but  meat  only  at  one,  or 
at  most  two ;  the  latter  when  only  a  small  portion  at  once  is  al- 
lowed. When  in  health  they  should  have  no  wine  or  beer  except 
as  a  festive  treat,  no  coffee,  strong  tea,  or  other  exciting  drink. 
Once-cooked  succulent  meat  without  sauces  or  condiments,  eggs, 
plenty  of  farinaceous  pudding,  mealy  potatoes,  carrots,  spinach, 
French  beans,  rice,  bread,  fresh  butter,  porridge,  roast  apples, 
oranges,  should  form  the  staple  of  the  nursery  commissariat. 

As  to  quantity,  we  may  take  the  full  diets  of  hospitals  as  fairly 
representing  what  should  be  the  minimum  proper  for  those  who 
are  not  restricted  by  fortune  in  the  matter  of  food,  and  the  mean 
amount  upon  which  a  growing  child  can  continue  to  flourish.  For 
it  may  be  observed  that  while  all  extravagance  is  herein  avoided, 
the  food  is  intended  mainly  for  those  who  are  convalescent  from 
acute  disease,  and  have  not  only  to  remain  well,  but  to  recover 
flesh. 

The  following  estimates  are  taken  from  the  published  tables  of 
diet.  The  quantities  named  are  those  which  may  be  fairly  put 
before  each  child  of  each  article,  and  by  selecting  the  larger  quan- 
tities we  may  give  a  very  full  allowance.  If  the  smaller  amounts 
of  one  are  eaten,  then  care  should  be  taken  that  the  fuller  weights 
of  others  are  chosen. 

And  let  it  always  be  understood  that  food  is  not  to  be  dispensed 
with  pedantic  accuracy  as  if  it  were  a  pharmaceutical  prescription. 
Even  in  hospitals  considerable  latitude  is  allowed,  and  still  more 
in  private  nurseries  should  we  avoid  making  life  a  toil  by  too 
much  interference.  It  is  only  in  cases  of  prominent  and  persist- 


CHILDHOOD    AND    YOUTH. 


135 


ent  excess  in  one  direction  or  the  other,  that  we  should  bring  our 
adult  reason  to  bear  on  infantile  instinct. 

Full  Dietaries  for  Children  at  various  Hospitals. 


Age. 

Bread. 

Butter. 

Milk. 

Meat. 

Vegetables. 

Pudding. 

Hospital. 

Under  7 

Unlimited. 

1  oz. 

%  pint. 

2oz. 

4  oz. 

Unlimited. 

St.  George's. 

Under  7 

12  oz. 

7 

}/2  pint. 

2oz. 

8  oz. 

(Twice  a 
\     week. 

London. 

Under  8 

5%oz. 

f  about 
1  %oz. 

y>  pint. 

2  oz. 

4  oz. 

^  pint. 

Children's  Hospi- 
tal, Great  Orm- 
ond  Street,  and 
Evelina   Hospi- 
tal. 

Under  8 

8  oz. 

{about 
1  oz. 

? 

2oz. 

4  oz. 

0 

Leeds  Infirmary. 

Above  8 

8  oz. 

/about 
t    loz. 

%pint.' 

(3oz. 
\  broth 
l^pnt 

6  oz. 

S  Gruel,  y3 
I     pint. 

1  Children's;    Great 
Ormond  Street, 
and    Evelina 
Hospital. 

Under  9 

6  oz. 

? 

1  pint. 

2oz. 

6  oz. 

f  14  pint 
-<     gruel  or 
(.    broth. 

f  Birmingham  Gen- 
\     eral  Hospital. 

Under  9 

7  oz. 

KOZ. 

1  pint. 

4oz. 

4  oz. 

To  order. 

St.  Bartholomew's. 

Under  10 

12  oz. 

%oz. 

1  pint. 

2oz. 

4  oz. 

6  oz. 

St.  Thomas's. 

Under  10 

6  oz. 

f 

114  pint. 

2  eggs. 

? 

8  oz. 

King's  College. 

Extreme  monotony  should  be  avoided.  It  is  a  great  inconve- 
nience to  young  persons  in  after-life  to  have  been  brought  up  in 
such  a  narrow  round  of  indubitably  wholesome  victuals  that  they 
cannot  eat  this  or  that.  They  should  especially  be  guarded  against 
family  whims;  and  if  the  parents  are  conscious  of  prejudices 
against  any  of  the  ordinary  foods  of  mankind,  they  should  edu- 
cate their  descendants  to  take  these  as  a  matter  of  course.  For  it 
is  astonishing  how  ingrained  some  of  these  acquired  idiosyncrasies 
become,  and  indeed  after  full  manhood  they  may  be  concealed  but 
are  never  quite  overcome.  Yet  few  of  the  minor  thorns  in  the 
rose-bed  are  so  vexatious  to  oneself  and  others.  I  shall  not  soon 
forget  the  annoyance  of  taking  a  young  man  to  a  Greenwich  din- 
ner, and  finding  that  he  never  ate  anything  which  swam  in  the 
waters.  Thus  occasional  abstinence,  in  the  shape  of  no  meat  or 
the  substitution  of  fish,  and  occasional  festivities,  consisting  of  food 
given  deliberately  because  it  is  nice,  are  not  out  of  place  in  the 

1  Including  what  is  put  in  mashed  potatoes. 


136  SPECIAL    DIETETICS    OP    HEALTH. 

nursery.  Most  kind  fathers  and  mothers  act  on  this  principle, 
but  they  sometimes  needlessly  let  the  indulgence  trouble  their 
conscience. 

The  articles  of  diet  should  be  as  good  and  as  clean  as  can  be 
obtained,  but  no  criticism  should  be  permitted  to  those  who  sit  at 
table.  A  boy  or  girl  should  be  ready  to  eat  anything  which  is  set 
before  them,  and  not  refuse  even  badly  cooked  or  strange  meats  ; 
for  in  roughing  it  through  the  world,  whatever  position  they  are 
in,  the  choice  often  lies  between  that  and  going  without. 

The  plan  adopted  at  many  schools  of  working  before  breakfast 
is  not  conducive  to  health.  If  it  is  inconvenient  for  the  house- 
hold to  prepare  the  meal  immediately  the  pupils  are  dressed,  the 
most  that  should  be  exacted  is  the  repetition  of  some  light  task 
prepared  overnight ;  but  better  than  that  is  to  let  them  have  half 
an  hour's  run  in  the  play -ground.  Violent  exertion  also  of  mind 
or  body  before  and  after  other  meals  should  be  discouraged  by  a 
suitable  arrangement  of  the  hours  of  work  and  play.  ^Esthetic 
pursuits,  drawing,  dancing,  singing,  may  be  made  so  to  combine 
relaxation  and  amusement  as  to  leave  the  powers  of  digestion  un- 
exhausted, and  may  be  practiced  up  to  the  time  of  meals. 

To  the  full  development  of  the  digestive  organs,  muscular  ex- 
ertion in  the  open  air  is  essential,  and  it  is  doubly  valuable  when 
it  is  of  a  pleasurable  character.  Proper  exercise  always  involves 
a  rational  style  of  dress ;  for  ill  fitted  and  uncomfortable  clothing 
is  soon  rejected  by  those  who  rejoice  in  the  natural  movement  of 
the  limbs. 

It  is  even  more  necessary  for  girls  than  for  boys  that  a  sufficient 
playground  should  be  attached  to  places  of  education,  for  they 
cannot  be  allowed  to  wander  about  the  country  like  their  brothers, 
and  the  funeral  processions  falsely  called  exercise  are  almost  use- 
less. In  town,  gymnastics  or  riding  on  horseback  may  be.  made 
substitutes  for  games ;  but  the  money  required  for  these  would  be 
much  more  profitable  if  expended  in  the  rent  of  a  field  or  lawn. 

For  families  who  are  so  fortunate  as  to  be  near  a  river  or  lake 
there  is  no  exercise  for  girls  so  good  as  rowing  a  light  oar  or  scull- 
ing. It  opens  the  chest,  throws  back  the  shoulders,  straightens 
the  back,  and  insures  the  shoulder  straps  of  the  dress  not  imped- 
ing movement,  so  that  the  liver  and  stomach  gain  space  to  act. 

Many  a  sculpturesque  figure  will  acknowledge  her  debt  to  her 


CHILDHOOD    AND    YOUTH.  137 

boat  for  her  beauty ;  and  a  few  weeks'  instruction  in  swimming 
at  Dieppe  or  Trouville  takes  away  all  sense  of  clanger  from  the 
amusement. 

Up  to  the  period  of  puberty  the  daily  use  of  wine  should  be 
allowed  only  during  illness  and  by  the  express  advice  of  a  medi- 
cal man.  Its  habitual,  consumption  by  healthy  children  hastens 
forward  that  crisis  in  their  lives,  checks  growth,  and  so  habituates 
them  to  the  artificial  sensation  induced  by  alcohol  that  they  can 
scarcely  ever  leave  it  off  when  they  wish.  This  restriction  does 
not  exclude  occasional  festivities,  and  boys  in  active  exercise  seem 
to  digest  well  a  glass  of  well-brewed  beer  at  dinner. 

Between  puberty  and  full  growth  the  principal  thing  we  have 
to  guard  young  people  against  is  overloading  the  stomach.  Their 
meals  should  be  sufficiently  frequent  to  avoid  this,  otherwise  the 
stomach  from  habitual  distension  becomes  larger  than  is  appro- 
priate for  the  size  of  the  trunk,  and  there  is  in  after-life  a  tendency 
to  gastric  flatulence.  Lads  sent  to  learn  a  business  in  the  city  are 
often  much  neglected  in  the  matter  of  a  midday  meal,  and  have 
to  make  up  for  it  by  gorging  themselves  in  the  evening.  This 
spoils  their  breakfast  next  morning,  and  they  really  get  starved 
from  over-repletion.  The  best  luncheon  a  growing  young  man 
can  have  is  a  dish  of  roast  potatoes,  well  buttered  and  peppered, 
and  a  draught  of  milk.  Or  the  same  vegetable  with  a  little  bacon 
or  fish  may  be  made  into  a  Cornish  pastry,  which  if  wrapped  up 
in  flannel  will  keep  hot  for  several  hours.  In  the  summer  boiled 
beans  and  bacon,  or  bread  and  cheese  and  lettuce,  with  a  glass  of 
claret  or  a  draught  of  bitter  beer,  may  take  its  place.  But  let  the 
repast  be  confined  to  one  dish,  and  then  they  will  not  eat  too 
much.  Red  meat  in  the  middle  of  the  day  is  too  heating  during 
active  life,  so  that  if  the  conventional  form  of  a  sandwich  is  the 
only  convenient  lunch  found  practicable,  let  it  be  made  of  eggs, 
or  fowl,  or  cold  fish,  flavored  with  a  little  salad  dressing,  or  the 
like. 

Youth  is  the  time  when  gluttonous  habits  are  acquired.  The 
commencement  of  them  is  easily  detected,  and  they  should  un- 
sparingly be  made  as  disgraceful  as  they  really  are.  Ridicule  is 
not  always  a  wise  engine  to  employ  in  education — it  is  too  power- 
ful— but  against  gluttony  it  may  fairly  be  used.  Let  it  not, 
however,  be  supposed  that  excess  in  gratifying  the  palate  is  at  all 


138  SPECIAL    DIETETICS    OF    HEALTH. 

a  laughing  matter.  It  is  a  vice  just  as  truly  as  sexual  excess  is  a 
vice ;  and  there  is  the  less  excuse  for  its  becoming  an  habitual 
vice,  in  the  fact  that  the  temptation  to  acquire  it  is  strongest  in 
youth,  and  becomes  weaker  as  full  growth  is  attained.  That  it  is 
regarded  as  a  serious  vice  by  the  highest  authority  is  shown  to  all 
time  by  that  Avonderful  history  of  the  civilization  of  a  specially 
favored  race  preserved  in  the  commonest  of  books.  Kibroth- 
Hataavah — "  The  Graves  of  the  Greedy  " — remained  for  future 
generations  as  a  standing  memorial  of  Heaven's  wrath,  and  of  the 
natural  punishment  of  sins  against  natural  law.  The  worldly 
Lord  Chesterfield  is  equally  explicit  in  denouncing  the  vice,  when 
writing  to  his  son  at  school,  and  though  his  outspoken  sentences 
are  couched  in  language  too  old-fashioned  for  quotation,  they  are 
well  worthy  of  the  attention  of  both  parents  and  children. 

The  gorging  themselves  with  pastry  and  sweetstuff  at  the  con- 
fectioner's, as  practiced  habitually  by  school-boys,  and  often  by 
girls  when  they  get  a  chance,  lays  the  foundation  not  only  for  in- 
digestion in  after  years,  which  is  its  least  evil,  but  also  for  a  habit 
of  indulgence  which  is  a  curse  through  life.  A  schoolmaster  who 
should  effectually  check  this  without  needless  restriction  of  liberty, 
and  make  greediness  unfashionable  among  his  pupils,  I  would 
rank  far  above  the  most  finished  scholar  in  Europe.  An  impor- 
tant step  towards  it  is  to  give  the  boys  enough  to  eat  at  regular 
mealtimes. 

Yet  are  asceticism  and  hypocrisy  to  be  equally  eschewed  with 
gluttony.  The  hearty  enjoyment  of  what  is  pleasant  to  the  taste 
at  proper  times  is  quite  consistent  with,  indeed  usually  goes  along 
with,  habitual  temperance ;  and  one  of  the  most  practical  lessons 
knowledge  of  the  world  can  teach  is  that  all  pleasure  is  enhanced 
by  self-restraint. 

Young  people  should  not  be  brought  up  to  the  habit  of  taking 
physic.  As  a  rule,  the  British  mother  is  very  fond  of  dabbling  in 
doctoring,  and  apt  to  try  her  first  experiments  on  her  own  family. 
If  there  is  any  definite  disease  discoverable,  a  professional  man  is 
called  iu,  but  if  a  child  is  only  weakly,  or  troubled  now  and  then 
with  unimportant  ailments,  she  tries  this  and  that  which  has  been 
recommended  by  her  friends,  without  suspecting  the  probable 
truth  that  the  cause  of  the  imperfect  condition  lies  in  some  irra- 
tional regimen  pursued.  She  cannot  make  out  what  is  the  matter; 


CHILDHOOD    AND    YOUTH.  139 

surely  it  would  be  wiser  to  consult  some  one  who  can,  or  at  all 
events,  who  knows  that  he  cannot,  and  will  not  act  till  he  does. 
The  consequence  of  frequent  drugging  is  sometimes  real  illness, 
generally  a  debilitated  state  of  the  digestion,  and  almost  always  a 
disposition  to  fly  to  drugs  for  the  immediate  relief  of  petty  incon- 
veniences, which  in  reality  impedes  their  cure  by  more  far-sighted 
means.  Boys  get  laughed  out  of  this  at  school,  but  girls  are 
seldom  so  fortunate,  and  grow  up  with  the  idea  that  something 
which  calls  itself  physic  is  a  necessity  of  human  life.  Now,  in 
all  the  pharmacopoeias  there  is  not  a  single  active  article  which, 
joined  to  its  virtues,  has  not  the  vice  of  deranging  more  or  less 
gastric  digestion.  It  is  that  which  makes  it  a  medicine  and  not  a 
food.  Assuredly,  its  secondary  or  final  effect  in  suitable  cases,  is 
to  restore  digestion,  but  when  taken  needlessly,  it  cannot  but  be 
injurious  even  to  such  a  tough  animal  as  a  boy.  The  proper  place 
for  the  family  medicine  chest  is,  not  the  bed-room  or  the  boudoir, 
but  the  store-room,  where  there  is  some  little  trouble  in  getting  at 
it,  and  where  it  should  be  locked  up  along  with  a  stomach-pump, 
and  other  provisions  for  emergencies  to  be  applied  by  skilful 
hands. 


140  SPECIAL    DIETETICS    OF    HEALTH. 


CHAPTER  III. 

COMMERCIAL    LIFE. 

THE  continually  increasing  numbers  who  devote  themselves  to 
commercial  pursuits,  and  the  still  larger  numbers  whom  they  in- 
fluence as  dependants  as  they  grow  in  importance,  make  the  habits 
of  the  class  a  matter  of  serious  social  consideration. 

The  commercial  man  measures  his  usefulness  in  the  world  "by 
his  success  in  rapidly  accumulating  honest  wealth.  Honesty, 
therefore,  being  presupposed,  the  most  conscientious  is  always  lia- 
ble to  the  temptation  of  wishing  to  compress  two  days'  work  into 
one,  so  as  to  be  rich  in  half  the  time  taken  by  his  neighbors.  To 
speak  of  this  as  a  "struggle  for  life,"  is  silly;  of  those  who  labor 
hardest  in  our  cities,  there  are  very  few  who  would  not  acknowl- 
edge that  one-tenth  of  their  anxious  toil  would  supply  the  daily 
needs  of  themselves  and  families.  They  are  in  reality  egged  on 
by  ambitious  rivalry,  which  uses  for  its  purposes  that  insatiable 
hunger  for  hard  work  innate  in  the  British  breast.  The  haste  to 
be  rich  is  most  unwise,  and  not  only  often  defeats  its  own  purpose 
by  prematurely  incapacitating  the  haster  from  further  struggles, 
but  if  it  is  successful,  it  surely  deprives  middle  life,  or  at  least  old 
age,  of  its  occupation. 

A  man  whose  unusual  exertions  have  made  him  rich  rapidly, 
is  sure  to  have  been  too  much  engrossed  by  his  business  to  take 
an  interest  in  other  things.  He  may  have  kept  himself,  as  a  duty, 
acquainted  with  the  pursuits  and  sympathies  of  his  fellows,  but 
he  is  incapable  of  making  them  the  occupation  of  his  thoughts. 
He  is  driven  to  look  to  the  past  only  for  the  genuine  interest  of 
life. 

Much  more  often  the  health  suddenly  breaks  down  before  the 
desired  object  is  attained,  and  the  power  is  wanting  to  engage  in 
other  pursuits,  to  take  the  place  of  business  which  is  perforce 
given  up.  The  expenditure  of  strength,  in  the  hurry  to  grasp 
wealth,  has  resulted  only  in  weakness  and  poverty. 


COMMERCIAL    LIFE.  141 

It  was  a  piece  of  shrewd  advice  administered  by  an  old  mer- 
chant to  a  young  one — "  If  you  want  to  die  rich,  live  as  long  as 
you  can." 

The  most  important  rule  for  one  engaged  in  any  business  which 
involves  headwork  or  responsibility  to  lay  down  for  himself  is  to 
strictly  confine  his  business  to  its  own  times  and  places.  Retail 
shopkeeping  of  all  employments  allows  the  greatest  number  of 
hours  to  be  occupied  in  attention  to  its  interests ;  for,  if  fairly  pros- 
perous, it  does  not  exhaust  the  brain,  and  yet  offers  the  gentle 
stimulus  of  movement  and  conversation.  However,  the  principals 
of  many  large  concerns  of  this  kind  are  more  heavily  weighted, 
and  if  they  want  to  enjoy  health  must  draw  a  strict  line  between 
the  hours  devoted  to  money-making  and  those  devoted  to  living, 
just  as  much  as  if  they  were  merchants  or  manufacturers. 

The  result  of  a  neglect  of  this  rule,  of  bringing  the  counting- 
house  into  the  dining-room  and  bed-room,  is  indigestion  and 
sleeplessness. 

The  principal  meals  should  be  breakfast  and  dinner,  breakfast 
before  and  dinner  after  the  work  of  the  day.  But  a  break  in  the 
middle  for  luncheon  is  very  important,  indeed  is  imperative  for 
all  but  exceptional  cases.  At  breakfast  and  dinner,  animal  food 
is  necessary  to  a  hard  worker;  but  it  is  not  required  at  luncheon, 
and  often  causes  heaviness  and  feverishness  during  the  afternoon. 
Any  large  quantity  of  fat  or  butter  also  seems  heating,  especially 
if  it  is  cooked,  as  in  pastry.  Farinaceous  food,  vegetables,  fruit, 
should  be  the  staple  of  the  midday  meal,  with  only  so  much  of 
anything  else  as  is  wanted  for  a  relish,  the  less  the  better. 

Many  commercial  men  give  up  vegetables  because  they  find 
that  taken  at  a  mixed  meal,  along  with  meat,  they  cause  flatulence. 
If  they  will  separate  the  two  classes  of  food,  which  require  the 
digestive  powers  of  different  and  somewhat  opposite  solvents,  the 
saliva  and  the  gastric  juice,  if  they  will  take  vegetables  at  one 
meal  and  meat  at  another,  they  will  often  find  the  difficulty  over- 
come, and  full  quantities  of  both  digested  without  fermentation. 

The  habitual  use  of  stimulants  in  the  middle  of  the  day  is  to 
be  deprecated  ;  nevertheless  where  an  unusual  amount  of  cerebral 
exertion  has  been  gone  through,  a  cheerful  glass  of  wine  or  beer 
will  often  prevent  over-fatigue — let  not,  however,  the  demand  or 
the  supply  grow  a  daily  habit. 


142  SPECIAL    DIETETICS    OF    HEALTH. 

The  daily  use  at  dinner  of  a  moderate  amount  of  alcohol  in  some 
form  contributes,  I  am  sure,  to  the  health  of  brain-workers. 
Light  perfect  wine  is  the  best  form,  next  beer,  next  strong  wine 
and  water,  last  spirituous  liquors. 

Commercial  work  can  be  done  only  in  the  town,  and  it  must  be 
confessed  that  town  air  and  influences  are  not  the  most  favorable 
to  health.  On  this  score  many  nowadays  spend  their  nights  at 
long  distances  from  their  place  of  business,  so  that  no  more  time 
than  is  absolutely  essential  should  be  spent  at  a  disadvantage. 
The  success  attendant  upon  this  plan  of  residence  in  the  country 
is  closely  proportioned  to  the  earliness  of  the  time  at  which  busi- 
ness can  be  left.  Unless  an  hour  or  two  can  be  given  to  relaxa- 
tion in  the  purer  air  before  dinner,  I  do  not  think  the  labor  of 
rdshing  backwards  and  forwards  is  compensated  for.  It  is  pleas- 
ant, doubtless,  to  see  the  junior  branches  of  the  family  flourishing 
among  green  fields,  but  not  when  the  bloom  is  gained  by  the  ex- 
haustion of  the  bread-winner's  strength.  Those  who  can  afford 
it,  will  do  better  to  fix  their  permanent  residence  near  their  work, 
and  live  temporarily  in  the  country  for  a  few  months  during  the 
long  days. 

Besides  the  reason  mentioned  above  another  may  be  given  for 
the  long  hours  borne  by  retailers,  namely,  that  their  shops  are 
better  ventilated  and  lighted  than  most  of  even  the  wealthiest 
merchants'  counting-houses.  To  pass  from  the  magnificent  dwell- 
ing of  his  wife  and  daughters  to  the  dull  stuffy  den  of  many  a 
prince  of  commerce,  recalls  the  image  of  Samson  grinding  in  the 
dark  through  the  treason  of  his  money-loving  spouse.  Things 
were  not  so  bad  when  the  family  lived  over  the  offices,  and  a 
softening  female  influence  civilized  the  whole  house.  But  now 
work  and  life  seem  to  be  seeking  a  divorce  from  one  another,  and 
the  place  of  business  is  growing  more  and  more  gruesome,  and, 
like  another  ill-omened  locality,  is  not  to  be  alluded  to  in  polite 
society.  A  ladies'  mission  for  the  improvement  of  these  dwellings 
is  urgently  called  for.  Unlike  other  missions,  it  could  dispense 
with  promoters,  secretaries,  speeches,  committees,  subscriptions, 
and  collectors.  Or  rather,  all  these  agencies  united  could  embark 
in  the  family  conveyance,  or  even  in  a  one-horse  fly,  and  begin 
operations  at  once  with  a  builder  and  decorator  as  assessor.  The 
scale  of  expenditure  should  be  proportioned  to  that  of  the  other 


COMMERCIAL    LIFE.  143 

home ;  it  will  probably  add  very  little  to  the  yearly  bills,  nothing 
in  comparison  to  silk  gowns  and  spring  bonnets. 

The  healthiest  exercise  for  a  commercial  man  is  riding  when  it 
is  possible.  It  diverts  the  thoughts,  especially  if  the  nag  be 
skittish,  prevents  the  stagnation  of  the  abdominal  bloodvessels, 
and  promotes  a  due  flow  of  bile.  But  the  outside  of  an  omnibus 
is  better  than  nothing  at  all,  and  is  within  the  means  of  every  one. 
Much  walking  is  usually  found  too  fatiguing,  and  if  adopted  as  a 
duty,  is  apt  to  be  monotonous.  Boating  and  cricket  are  suitable 
for  the  younger  members  of  the  commercial  world,  but  they  oc- 
cupy more  time  than  can  often  be  spared,  and  have  to  be  kept  for 
holidays.  The  more  violent  athletic  sports  are  open  to  still  more 
objection,  and  if  it  is  attempted  to  pursue  them  at  the  same  time 
that  the  thoughts  are  occupied  in  business,  they  exhaust  the  vital 
powers,  and  weakness  is  the  result. 


144  SPECIAL    DIETETICS    OF    HEALTH. 


CHAPTER  IV. 

LJTERAKY  AND   PROFESSIONAL   LIFE. 

THAT  dogmatic  expression  of  Biichner's,  "  No  thinking  with- 
out phosphorus,"1  has  gained  an  unhappy  notoriety.  Strictly 
taken  it  is  a  groundless  assumption,  for  it  is  impossible  for  us  to 
have  any  evidence  that  intellectual  being  may  not  exist  joined  to 
any  form  of  matter,  or  quite  independent  of  matter  at  all.  We 
certainly  do  not  know  enough  of  the  subject  to  lay  down  a  nega- 
tive statement.  And  if  it  be  held  to  mean  that  the  amount  of 
phosphorus  passing  through  the  nervous  system  bears  a  proportion 
to  the  intensity  of  thought,  it  is  simply  a  misstatement.  A  cap- 
tive lion,  tiger,  or  leopard,  or  hare,  who  can  have  wonderfully 
little  to  think  about,  assimilates  and  parts  with  a  greater  quantity 
of  phosphorus  than  a  professor  of  chemistry  working  hard  in  his 
laboratory ;  while  a  beaver,  who  always  seems  to  be  contriving 
something,  excretes  so  little  phosphorus,  at  least  in  his  urine,  that 
chemical  analysis  cannot  detect  it.2  All  that  the  physiologist  is 
justified  in  stating  is  that  for  the  mind  to  energize  in  a  living 
body,  that  body  must  be  kept  living  up  to  a  certain  standard,  and 
that  for  .this  continuous  renewal  of  life  a  supply  of  phosphatic  salts 
is  required.  The  same  may  be  said  with  equal  justice  of  water, 
fat,  nitrogen,  chloride  of  sodium,  oxygen,  etc.  The  phosphates 
are  wanted  indeed,  but  wanted  by  pinches,  whilst  water  must  be 
pouring  in  by  pailfuls.  One  might  go  on  thinking  for  weeks 
without  phosphates,  but  without  water  a  few  days,  and  without 
oxygen  a  few  minutes,  would  terminate  the  train  of  self-conscious- 
ness. The  practical  points  taught  us  by  physiology  are  that  for 
the  integrity  of  thought  the  integrity  of  the  nervous  system  is 
requisite ;  and  for  the  integrity  of  the  nervous  system  a  due 
quantity  of  such  food  as  contains  digestible  phosphatic  salts. 

1  Ohne  Phosphor  kein  Gedanke,  Kraft  und  Stoff,  sec.  122. 

2  See  the  analyses  of  the  several  kinds  of  urine  in  Simon's  Chemistry,  vol. 
ii,  pp.  144,  342,  and  350. 


LITERARY    LIFE.  145 

For  the  intellectual  direction  of  the  nervous  system  it  is  at  the 
same  time  essential  that  it  should  not  be  oppressed  by  physical 
and  mechanical  difficulties.  The  presence  in  the  stomach  or  blood 
of  imperfectly  assimilated  nutriment  impedes  its  functions  in  close 
proportion  to  their  amount ;  so  that  not  only  the  chemical  constit- 
uents but  the  mode  of  administering  food  must  come  into  the  cal- 
culation. 

The  most  perfect  regimen  for  the  healthy  exercise  of  thought  is 
such  as  would  be  advised  for  a  growing  boy,  frequent  small  sup- 
plies of  easily  soluble  mixed  food,  so  as  to  supply  the  greatest 
quantity  of  nutriment  without  overloading  the  stomach  or  running 
the  risk  of  generating  morbid  half-assimilated  products. 

The  physiology  of  the  action  of  alcohol  has  a  very  practical 
bearing  on  the  physical  regimen  of  the  mental  functions.  Alcohol 
has  the  power  of  curbing,  arresting,  and  suspending  all  the 
phenomena  connected  with  the  nervous  system.  We  feel  its  in- 
fluence on  our  thoughts  as  soon  as  on  any  other  part  of  the  man. 
Sometimes  it  brings  them  more  completely  under  our  command, 
controls  and  steadies  them ;  sometimes  it  confuses  or  disconnects 
them ;  then  breaks  off  our  power  and  the  action  of  the  senses  alto- 
gether. The  first  effect  is  desirable,  the  others  to  be  avoided. 
When  a  man  has  tired  himself  with  intellectual  exertion,  a  moder- 
ate quantity  of  alcohol  taken  with  food  acts  as  an  anaesthetic,  stays 
the  wear  of  the  system  which  is  going  on,  and  allows  the  nervous 
force  to  be  diverted  to  the  due  digestion  of  the  meal.  But  it  must 
be  followed  by  rest  from  mental  labor,  and  is  in  fact  a  part  of  the 
same  regimen  which  enforces  rest — it  is  an  artificial  rest.  To  con- 
tinue to  labor  and  at  the  same  time  to  take  the  anaesthetic  is  an 
inconsistency.  It  merely  blunts  the  painful  feeing  of  weariness, 
and  prevents  it  from  acting  as  a  warning.  I  very  much  doubt 
the  quickening  or  brightening  of  the  wits  which  bacchanalian 
poets  have  conventionally  attributed  to  alcohol.  An  abstainer  in 
a  party  of  even  moderate  topers  finds  their  jokes  dull  and  their 
anecdotes  pointless,  and  his  principal  amusement  consists  in  his 
observation  of  their  curious  bluntness  to  the  absurdity  of  their 
merriment. 

There  is  no  more  fatal  habit  to  a  literary  man  than  that  of 
using  alcohol  as  a  stimulant  between  meals.  The  vital  powers  go 
on  getting  worn  out  more  and  more  without  their  cry  for  help- 

10 


146  SPECIAL    DIETETICS    OF    HEALTH. 

being  perceived,  and  in  the  end  break  down  suddenly  and  ofte 
irrevocably.  The  temptation  is  greater  perhaps  to  a  literary  ma 
than  to  any  other  in  the  same  social  position,  especially  if  he  ha 
been  induced  by  avarice  or  ambition  to  work  wastefully  agains 
time;  and  if  he  cannot  resist  it  he  had  better  abjure  the  use  c 
alcohol  altogether. 

As  to  quantity,  the  appetite  for  solid  food  is  the  best  guide.    I 
a  better  dinner  or  supper  is  eaten  for  a  certain  amount  of  fermentei 
liquor  accompanying  it,  that  is  the  amount  most  suitable.     If 
worse,  then  it  may  be  concluded  that  an  excess  is  committed,  how 
ever  small  the  cup  may  be. 

Although  nothing  can  take  the  place  of  alcohol  in  this  article  o 
diet,  yet  fermented  drinks  are  not  suited  to  the  nervous  system  a 
all  in  proportion  to  their  alcoholic  contents.  The  fruity  ether 
and  aromas  evolved  in  the  process  of  fermentation,  and  which  d 
not  seem  capable  of  existing  in  a  digestible  form  without  alcohol 
are  even  more  powerful  in  repairing  the  waste  of  the  nerve  power 
Burgundy  has  acquired  a  special  fame  as  food  for  the  brain,  an< 
claret  runs  it  hard,  while  good,  sound,  unadulterated  beer  is  i 
homely  creature  little  inferior  to  them.  All  of  these  are  superio 
to  sherry  and  port,  and  to  spirits,  for  reasons  given  in  a  forme 
chapter  of  this  volume  on  the  choice  of  food. 

Mental  activity  certainly  renders  the  brain  less  capable  o 
bearing  an  amount  of  alcohol  which  in  seasons  of  rest  and  relaxa 
tion  does  not  injuriously  affect  it.  When  any  extraordinary  toi 
is  temporarily  imposed,  extreme  temperance  or  even  total  absti 
nence  should  be  the  rule.  Much  to  the  point  is  the  experience  o 
Byron's  Sardanapalus : 

"  The  goblet  I  reserve  for  hours  of  ease, 
I  war  on  water." 

The  posture  of  the  body  usually  adopted  by  literary  and  man} 
professional  persons  engaged  in  writing  is  a  matter  worth  consider- 
ation. Chamber  counsel  are  notoriously  subject  to  piles  am 
venous  congestion  of  the  rectum  ;  women  who  sit  much  with  theii 
work  in  front  of  them  get  also  congestion  and  irregularity  of  th< 
uterine  organs ;  cold  feet  from  sluggish  arterial  circulation  an 
frequently  complained  of  by  otherwise  hearty  sedentary  workers 
The  ill  health  which  these  symptoms  indicate  may  often  be  pre- 


LITERARY    LIFE.  147 

vented  by  the  use  of  a  high  desk  at  which  the  work  may  be  done 
standing  for  a  time  now  and  then ;  and  a  further  change  of  pos- 
ture may  be  obtained  by  an  easy  chair  which  will  allow  of  think- 
ing with  the  body  thrown  back  and  by  occasional  walks  about  the 
room. 

Athletic  sports  are  scarcely  consistent  with  steady,  hard  brain- 
work.  Probably  only  the  most  muscular  try  to  persist  in  them, 
and  they  acknowledge  that  their  intellects  are  readiest  and 
strongest  when  they  are  taking  quite  moderate  exercise,  and  not 
when  their  muscles  are  corky  and  their  limbs  light.  There  is  a 
peculiar  state  of  health  into  which  those  are  apt  to  fall  who, 
having  for  a  long  period  kept  themselves  in  training  for  boat- 
racing  or  other  muscular  exertion,  afterwards  adopt  a  life  which 
involves  mental  labor  and  responsibility,  even  though  they  get  a 
fair  amount  of  bodily  relaxation.  The  leading  symptoms  are 
emaciation,  weariness,  depression  of  spirits,  and  an  unnaturally 
high  specific  gravity  in  the  urine,  which  is,  however,  abundant 
and  full-colored,  thus  showing  an  excess  of  destructive  assimila- 
tion which  cannot  but  be  very  injurious. 

Fresh  air  and  relaxation  of  mind  are  of  more  importance  than 
exercise,  which  last  is  indeed  mainly  valuable  as  securing  them. 
The  limits  of  weariness  should  not  be  transgressed.  The  attempt 
to  compensate  for  excessive  literary  toil  by  excessive  bodily  toil  is 
based  on  a  false  conception  of  the  relations  of  matter  and  spirit, 
worthier  of  an  ancient  Gnostic  than  of  a  modern  philosopher, 
which  has  more  than  once  led  to  fatal  results.  I  had  for  some 
years  as  a  patient  a  literary  lady  who  wrote  much  and  well  in 
magazines.  She  would  go  straight  from  her  study  to  her  garden 
and  glebe,  dig  furiously  and  mow  with  a  scythe,  despising  -or 
rather  luxuriating  in  fatigue.  Gradually  paralysis  came  on,  show- 
ing itself  first  as  "writer's  cramp,"  and  then  creeping  over  the 
whole  body.  The  mind  and  senses  were  as  perfect  as  ever,  and  so 
long  as  she  was  able  to  move  the  tongue  she  dictated  lively  monthly 
articles,  and  at  last  died  apparently  of  sorrow  at  being  unable  to 
communicate  her  thoughts. 

Tobacco  should  not  be  indulged  in  during  working  hours. 
Whatever  physiological  effect  it  has  is  sedative,  and  so  obstructs 
mental  operations.  But  as  a  relaxation  afterwards  it  is  in  modera- 
tion beneficial.  As  a  calmative  before  retiring  to  rest  it  has  the 


148  SPECIAL    DIETETICS    OF    HEALTH. 

sanction  of  a  vigorous  brain  laborer,  John  Milton,  whose  supper, 
we  are  told,  consisted  of  bread,  water,  olives,  and  a  pipe  of  tobacco. 
There  is  a  flavor  about  the  fare  of  the  happy  days  he  had  passed 
with  an  elegant  literary  circle  in  Italy. 

The  daily  habits  of  Robert  Southey,  a  man  who  more  than  any 
other  made  literature  a  healthy  profession  and  'a  successful  profes- 
sion, are  thus  described  by  his  son  in  his  "Life,"  vol.  iii,  2,  and  vi, 
6  :  "  Breakfast  was  at  nine,  after  a  little  reading,  dinner  at  four, 
tea  at  six,  supper  at  half-past  nine,  and  the  intervals  filled  up  with 
reading  or  writing ;  except  that  he  regularly  walked  between  two 
and  four,  and  took  a  short  sleep  before  tea,  the  outline  of  his  day 
when  he  was  in  full  work  will  have  been  given.  After  supper, 
when  the  business  of  the  day  seemed  to  be  over,  though  he  gener- 
ally took  a  book,  he  remained  with  his  family,  and  was  open  to 
enter  into  conversation,  to  amuse  and  to  be  amused." 

"  My  actions,"  he  writes  about  this  time  to  a  friend,  "  are  as 
regular  as  those  of  St.  Dunstan's  quarter-boys.  Three  pages  of 
history  after  breakfast  (equivalent  to  five  in  small  quarto  print- 
ing) ;  then  to  transcribe  and  copy  for  the  press,  or  to  make  my  se- 
lections and  biographies,  or  what  else  suits  my  humor,  till  dinner- 
time ;  from  dinner  till  tea  I  read,  write  letters,  see  the  newspaper, 
and  very  often  indulge  in  a  siesta ; — for  sleep  agrees  with  me,  and 
I  have  a  good  substantial  theory  to  prove  that  it  must ;  for  if  a 
man  who  walks  much  requires  to  sit  down  and  rest  himself,  so 
does  the  brain,  if  it  be  the  part  most  worked,  require  its  repose. 
Well,  after  tea  I  go  to  poetry,  and  correct  and  re-write  and  copy 
till  I  am  tired,  and  then  turn  to  anything  else  till  supper;  and 
this  is  my  life — which,  if  it  be  not  a  merry  one,  is  yet  as  happy  as 
heart  could  wish." 

And  a  very  rational  mode  of  living  it  was,  deserving  of  its  re- 
ward. The  country  air  and  quiet  among  the  lakes  and  moun- 
tains, the  association  with  kindred  and  loving  spirits,  the  old- 
fashioned  dinner-hour  excluding  uncongenial  society,  the  regular 
exercise,  and  the  sound  night's  rest,  with  temperance,  soberness, 
and  chastity,  preserved  his  mental  powers  fresh  and  vigorous  in 
old  age,  to  leave  to  future  generations  undying  memorials  of  sym- 
pathy with  all  that  is  best  in  humanity. 

Milton  describes  himself  as  "  with  useful  and  generous  labors 
preserving  the  body's  health  and  hardiness,  to  render  lightsome, 


LITERARY    LIFE.  149 

clear,  and  not  lumpish  obedience  to  the  mind,  to  the  cause  of  re- 
ligion and  our  country's  liberty,  when  it  shall  require  firm  hearts 
in  sound  bodies  to  stand  and  cover  their  stations." 

His  blindness  probably  interfered  with  the  activity  of  his  mus- 
cular discipline  in  later  years,  for  he  was  a  martyr  to  gout  towards 
the  end  of  his  life. 

Samuel  Johnson  is  another  type  of  the  literary  man  pure  and 
simple.  Scrofulous,  awkward,  hypochondriacal,  and  corpulent,  he 
was  averse  naturally  to  bodily  exertion,  yet  he  walked  a  good  deal, 
and  worked  steadily  and  patiently  without  bursts  of  industry  or 
idleness.  Passionately  fond  of  company  and  of  eating  and  drink- 
ing, he  restrained  himself,  and  indulged  only  when  the  labor  of 
the  day  was  over.  His  knowledge  of  physiology  and  medicine 
kept  him  from  quackery,  and  his  medical  advisers  were  the  most 
rational  physicians  of  the  day.  After  middle  life,  his  own  obser- 
vation of  his  health  led  him  to  abstain  entirely  from  wine;  I  have 
heard  my  grandmother  describe  the  air  of  dignified  patience  with 
whieh  he  passed  the  bottle  which  she  often  pressed  upon  him  at 
her  father's. table.  He  sat  up  late  at  night  indeed,  yet  that  \vas 
not  for  work,  but  to  rest  the  mind  with  sportive  and  varied  con- 
versation. He  had  his  reward  in  the  retention  of  his  mind,  even 
when  its  material  organ  had  broken  down. 

Shelley  was  a  vegetarian,  and,  perhaps,  his  peculiar  way  of 
living,  combined  with  the  fact  of  not  writing  for  a  livelihood  or 
to  please  others,  estranged  his  sympathies  from  human  kind.  But 
at  all  events,  his  temperance  did  not  weaken  his  exuberance  of 
thought  and  diction.  What  would  have  happened  had  he  con- 
sumed more  phosphorus,  it  is  impossible  to  say ;  but  he  could 
hardly  have  been  a  more  rapid  composer  or  stronger  wielder  of 
words. 

Walter  Scott  passed  a  genial  sociable  existence,  took  much  ex- 
ercise, dissuaded  his  younger  friends  from  substituting  gig-driving 
for  riding,  and  always  insisted  on  having  seven  or  eight  hours  of 
utter  unconsciousness  in  bed.  Had  he  passed  his  whole  life  in 
his  study,  he  would  have  written  probably  worse  and  certainly 
less,  for  he  would  have  had  a  shorter  life  to  write  in. 

It  is  true  that  Byron  assumes  in  his  poetry  the  character  of  a 
debanche,  and  says  he  wrote  "  Don  Juan  "  under  the  inspiration 
of  gin  and  water.  But  much  of  that  sort  of  talk  is  merely  for 


150  SPECIAL    DIETETICS    OP    HEALTH. 

stage  effect,  and  \ve  see  how  industrious  he  was,  and  read  of  his 
training  vigorously  to  reduce  corpulence,  and  of  his  being  such  an 
exceptionally  experienced  swimmer  as  to  rival  Leander  in  crossing 
the  Hellespont. 

It  is  especially  when  the  mind  of  genius  is  overshadowed  by 
the  dark  cloud  of  threatened  insanity,  of  hypochondriasis,  or  of 
hysteria,  that  a  rational  regimen  preserves  it  to  the  glory  of  God 
and  the  advantage  of  man.  Nothing  but  daily  exercise,  temper- 
ate meals,  and  a  punctual  observance  of  regular  hours  of  study  and 
rest,  could  have  kept  burning  the  flickering  candle  of  reason  in 
poor  suicidal  Cowper.  Most  rarely  and  faintly  do  his  writings 
exhibit  a  trace  of  the  gloom  which  made  life  to  him,  as  he  de- 
scribed it  in  his  last  words,  "unutterable  misery." 

On  the  other  hand,  the  keen  poison  of  his  own  genius  slew  in 
youth  Kirke  White,  when  he  surrendered  himself  to  its  exclusive 
cultivation : 

That  eagle's  fate  and  his  were  one, 
Who  on  the  shaft  that  made  him  die 

Beheld  a  feather  of  his  own, 

Wherewith  he  wont  to  soar  so  high. 

The  elegant  appreciater  of  nature,  the  author  of  "  The  Seasons," 
faded  away  from  lazy  and  self-indulgent  habits.  The  great  all- 
loving  soul  of  Burns  produced  so  little  because  it  was  drenched  in 
drink  and  idleness,  not  excessive  indeed,  but  sufficient  to  ruin  his 
usefulness. 

Apropos  of  this  last  matter,  we  may  give  to  some  people  the 
same  caution  which  Swift  administers  in  a  letter  to  Pope :  "  The 
least  transgression  of  yours,  if  it  be  only  two  bits  and  a  sup  more 
than  your  stint,  is  a  great  debauch,  for  which  you  will  certainly 
pay  more  than  those  sots  who  are  carried  dead  drunk  to  bed." 
The  machinery  of  sensitive  souls  is  as  delicate  as  it  is  valuable, 
and  cannot  bear  the  rough  usage  which  coarse  customs  inflict  upon 
it.  It  is  broken  to  pieces  by  blows  which  common  natures  laugh 
at.  The  literary  man,  with  his  highly  cultivated,  tightly  strung 
sensations,  is  often  more  susceptible  of  the  noxious  and  less  sus- 
ceptible of  the  beneficial  results  of  alcohol  and  other  indulgences 
than  others.  His  mind  is  easier  to  cloud,  and  there  is  a  deeper 
responsibility  in  clouding  it. 


LITERARY    LIFE.  151 

Equally  when  we  descend  into  the  lower  regions  of  Parnassus, 
the  abodes  of  talent  and  cleverness  and  the  supply  of  periodical 
literary  requirements,  we  find  the  due  care  of  the  body  absolutely 
essential  to  the  continued  usefulness  of  the  intellect.  The  first 
things  to  which  one  entering  the  profession  of  literature  must 
make  up  his  mind,  are  to  be  respectable  and  healthy. 

What  noble  fragments  one  finds  in  Savage  and  in  Poe !  and 
how  sad  to  know  that  they  are  fragments  instead  of  stately  struc- 
tures, solely  because  the  builders  had  not  the  wisdom  to  live  regular 
lives ! 


SPECIAL    DIETETICS    OF    HEALTH. 


CHAPTER  V. 

NOXIOUS    TRADES. 

THE  digestive  organs  are  liable  to  suffer  from  the  position  as- 
sumed at  work  by  certain  handicraftsmen,  and  the  discomfort 
hence  arising  leads  to  the  adoption  of  an  unwholesome  dietary, 
which  in  the  end  intensifies  the  evil. 

Shoemakers  contract  a  peculiar  sort  of  gastralgia,  partly  from 
the  pressure  of  the  last  against  the  epigastrium,  and  partly  from 
the  constriction  of  the  abdominal  viscera,  especially  the  stomach, 
by  leaning  so  far  forward  to  work.  The  use  of  the  upright  bench, 
in  which  the  last  is  held  firm  by  a  stirrup,  and  an  erect  posture 
always  preserved,  is  the  best  remedy  for  the  evil,  and  the  thanks  of 
the  country  are  due  to  Mr.  Sparkes  Hall  for  his  advocacy  of  this 
method  of  getting  over  a  difficulty  as  old  as  the  Pharaohs  at  least. 

Against  the  constipation  and  haemorrhoids  which  the  same  pos- 
ture induces  the  best  preservative  is  the  free  use  of  fresh  butter,  a 
cold  tub  every  morning,  and  an  occasional  dandelion  pill. 

The  discomfort  which  they  cause  in  a  sensitive  condition  of  the 
stomach  causes  vegetables  to  be  avoided  by  many  shoemakers. 
They  can  hardly  bear  to  take  sufficient  to  sustain  health.  So 
long  as  this  is  the  case,  they  should  eat  as  many  oranges  and 
lemons  as  they  can,  or  in  default  of  them,  fresh  rhubarb,  and  try 
the  plan  proposed  before  of  eating  vegetables  only  at  one  meal 
and  meat  alone  at  another.  A  small  quantity  of  watercresses  is 
also  a  great  resource. 

The  same  observations  apply  with  nearly  equal  force  to  tailors, 
but  unfortunately  they  have  not  the  refuge  of  the  upright  bench 
to  fly  to,  and  to  a  certain  extent  also  to  sewing-machine  workers, 
in  whose  case  I  would  suggest  that  a  simple  contrivance  by  which 
the  legs  of  the  instrument  could  be  shortened  or  lengthened  would 
enable  the  changes  of  posture  necessary  to  health  to  be  made. 

However,  it  is  indubitable  that  a  great  deal  of  the  ill-health  of 
all  classes  of  artisans  arises  from  the  closeness  of  their  work- 
rooms, and  a  more  philanthropic  deed  cannot  be  done  for  a  de- 


NOXIOUS    TRADES.  153 

serving  class  than  the  bringing  under  the  notice  of  the  district 
health-officers  instances  of  the  violation  of  the  law  by  masters. 

Gardeners  often  are  afflicted  with  water-brash,  arising  in  a 
measure  from  the  stooping  posture  deranging  the  viscera  which 
receive  the  food,  especially  the  lower  end  of  the  gullet.  But  I 
think  that  an  additional  cause  is  frequently  the  bad  cooking  of 
the  vegetables  they  eat.  Half-boiled  potatoes  and  cabbage  are  as 
injurious  as  ill-prepared  oatmeal  is  found  among  populations 
which  are  nourished  on  that  diet. 

The  poisoning  to  which  those  who  work  in  lead  are  exposed  by 
their  occupation  may  be  almost  always  prevented  by  scrupulous 
cleanliness  in  taking  food.  There  is  abundant  proof  that  the 
metal  enters  the  system  through  the  stomach,  and  there  is  but 
doubtful  evidence  of  its  entering  by  any  other  path.  From  dirty 
hands  it  gets  into  the  bread,  from  dusty  clothes  it  besprinkles  the 
meat  and  drink,  and  thus  acts  as  quickly  arid  surely  as  if  it  had 
been  brought  in  by  the  more  usual  way  of  the  drinking-water. 
It  is  the  most  certain  and  noxious  if  by  any  peculiarity  in  the 
manufacture  it  is  converted  into  a  chloride  salt,  but  the  form 
which  we  generally  meet  with  is  the  white  carbonate,  insoluble 
indeed  in  water,  but  unfortunately  soluble  in  the  fluids  of  the  di- 
gestive canal,  saturated  as  they  are  with  carbonic  acid.  In  the 
case  of  painters  who  employ  white  lead,  it  is  quickly  deprived  of 
some  of  its  noxiousness  by  mixture  with  oil,  for  in  that  condition 
it  can  only  get  into  the  food  from  the  hands.  But  where  the 
finely  powdered  or  precipitated  Kremnitz  lead  is  employed,  as 
for  example  in  the  manufacture  of  polished  cards,  the  clothes  be- 
come saturated  with  the  dust  and  convey  it  to  the  victuals.  Not 
only  should  the  hands  be  washed,  the  hair  brushed,  and  the  outer 
garment  shifted,  before  meals,  but  the  men  should  not  be  allowed 
to  bring  their  food  within  the  poison-laden  atmosphere  of  the 
workshops. 

Plumbers  are  said  to  inhale  lead  in  the  fumes  which  arise  in 
the  process  of  casting,  and  "  brass-founders'  ague  "  also  appears 
from  the  researches  of  Dr.  Greenhow  to  be  caused  by  the  fumes 
of  solder,  consisting  mainly  of  oxide  of  zinc,  being  drawn  into 
the  lungs.  But  it  must  be  remembered  that  in  both  these  handi- 
crafts a  great  deal  of  dirt  adheres  to  the  skin  and  clothes  and  may 
thus  pass  into  the  food.  I  have  never  seen  clean  men  affected. 


154  SPECIAL    DIETETICS    OF    HEALTH. 

Some  handicrafts  are  noxious  from  the  high  temperature  at 
which  they  are  obliged  to  be  carried  on.  In  these  cases,  the  fre- 
quent and  free  use  of  cold  drinking-water  is  sanctioned  by  expe- 
rience as  the  best  preservative  of  health ;  the  copious  evaporation 
from  the  skin  keeping  down  the  heat  of  the  blood.  And  the  most 
cruel  enemy  to  health  is  alcohol,  which  induces  degeneration  of 
the  liver,  heart,  or  kidneys,  or  all  these  at  once,  and  prevents  at 
any  rate  the  due  exercise  of  the  lungs'  functions,  even  if  it  does 
not  directly  disorganize  that  tissue.  My  own  impression  is  that 
the  emphysema  and  black  deposit  so  often  found  in  the  lungs  of 
artisans  exposed  to  great  heat  is  in  no  small  measure  due  to  alcohol 
and  to  the  neglect  of  its  antagonist  water. 

For  example,  the  consolidation  and  subsequent  breaking  down 
of  the  lung  peculiar  to  dry  grinders  is  seldom  if  ever  found  in 
temperate  men ;  a  healthy  mucous  membrane  has  the  power  of 
rejecting  the  foreign  particles  of  metal  which  adhere  to  it  when 
congested  and  degenerated. 

Colliers,  who  labor  in  the  dark  in  a  confined  hot  atmosphere 
deficient  in  oxygen,  suffer  from  bloodlessness  and  indigestion.  The 
bonesetters,  the  popular  practitioners  among  this  class,  describe 
it  as ~" a  little  bone  broke"  in  the  stomach,  pummel  the  abdomen 
and  make  the  patient  give  up  work  and  drink  for  a  season  with 
successful  result.  Philanthropic  coal-owners  should  arrange  the 
shifts,  so  that  a  man  may  be  put  in  turn  on  to  night  work  and 
have  his  share  of  sunlight.  And  it  is  better  for  the  men  not  to 
eat  in  the  pits,  but  to  make  their  principal  meals  when  off  work. 
The  diet  of  colliers  is  generally  too  nitrogenous  for  a  life  of  daily 
muscular  labor. 

Tea-tasters  sometimes  suffer  from  a  special  kind  of  nervous  af- 
fection. The  hand  gets  tremulous,  there  is  sleeplessness,  head- 
ache, anaemia,  indigestion,  with  a  flabby  tongue  covered  with  a 
smooth  yellow  coat.  To  avoid  this,  they  should  live  well,  and 
always  take  some  food  before  exercising  their  office.  Smelling 
the  tea  seems  to  be  more  injurious,  and  really  less  decisive,  than 
sipping  the  infusion. 

Evils  consequent  on  other  trades  are  not  mentioned  here,  either 
because  they  are  unconnected  with  diet,  and  not  to  be  avoided  by 
any  special  arrangement  of  diet,  or  else  resolve  themselves  simply 
into  temptations  to  intemperance. 


ATHLETIC    TRAINING.  155 


CHAPTER  VI. 

ATHLETIC  TRAINING. 

ARE  the  dramatist  and  the  novelist  drawing  from  nature  when 
they  present  us  a  picture  of  a  well-born  and  well-bred  athlete, 
stupid,  immoral,  selfish,  case-hardened  by  his  brute  strength 
against  the  finer  emotions  of  pity  and  honor,  and  blind  to  intel- 
lectual pleasures?  If  the  original  exists,  he  is  happily  very  rare. 
He  is  certainly  not  conspicuous  in  the  list  of  294  rowers  in  Uni- 
versity races  collected  by  Dr.  Morgan,  which  on  the  other  hand 
is  adorned  with  bishops,  poets,  public  school-masters,  leading  bar- 
risters, devoted  clergymen,  elegant  orators,  scientific  chemists, 
philanthropists,  and  other  ornaments  of  the  human  race.1  Emi- 
nent muscular  ability  evidently  is  not  inconsistent  with  a  superi- 
ority to  the  average  in  other  respects,  and  the  improvement  of 
the  body  does  not  prevent  the  improvement  of  the  mind. 

A  charge  more  serious,  because  more  troublesome  to  answer 
against  athletics,  is  that  they  lay  a  foundation  for  disease  in  after 
years,  and  thus  shorten  life.  Likely  enough  the  spectators  know 
that  the  dropping  down  dead  on  the  stage  of  an  athlete,  appar- 
ently in  the  height  of  healthy  vigor,  is  a  gross  misrepresentation 
of  nature.  But  yet  the  scene  rankles  in  their  memories,  and  they 
can  with  difficulty  divest  themselves  of  the  feeling  that  the  exuber- 
ant energy  of  a  man  in  training  wears  out  the  vital  forces,  and  is 
repaid  by  weakness  which  will  cut  short  the  days.  We  may  know 
that  the  impression  exists  by  the  frequency  with  which  the  friends 
of  patients  assign  athletics  as  the  cause  of  all  sorts  of  diseases, 
without  any  other  reason  than  that  the  failure  in  health  was  first 
made  manifest  during  some  bodily  exertion.  Of  course  it  is  during 
bodily  exertion  that  the  discovery  is  made :  no  one  finds  out  that 
his  legs  are  weak  till  he  tries  to  walk,  or  that  his  lungs  or  heart 
are  injured  till  his  wind  fails  him  at  a  pinch.  But  that  a  man 

1  University  Oars,  by  John  E.  Morgan,  H.D. 


156  SPECIAL    DIETETICS    OF    HEALTH. 

previously  in  good  health  injures  his  constitution  by  training,  so 
as  to  be  more  liable  than  ordinary  persons  to  any  peculiar  class  of 
disease  or  degeneration,  is  negatived  by  the  laborious  investiga- 
tions of  Dr.  Morgan.  He  has  followed  up  with  personal  inquiries 
the  294  "  university  oars  "  mentioned  above,  and  he  finds,  as  was 
to  be  expected,  that  since  1829,  when  his  list  begins,  some  have 
died,  some  have  been  killed,  some  have  fallen  into  ill  health,  but 
238  survive  to  describe  themselves  as  hearty  and  strong.  Of  the 
deaths  (39  in  all)  11  were  from  fevers,  7  from  consumption,  6 
from  accidents,  3  from  heart  disease,  and  lesser  numbers  from 
other  special  causes.  Now  it  is  heart  disease  which  especially  is 
attributed  to  athletic  sports,  and  it  is  a  surprise  to  find  statistics 
showing  that  their  patrons  have  suffered  from  it  rather  less  than 
the  rest  of  the  population,  and  much  less  than  the  sailors  whom 
we  are  so  solicitous  to  keep  in  good  health.1  Deaths  from  fevers 
certainly  cannot  be  considered  as  evidence  of  an  injured  constitu- 
tion ;  indeed  Dr.  Graves  of  Dublin  (a  high  authority  in  this  mat- 
ter) remarks,  and  the  experience  of  most  of  us  will  bear  him  out, 
that  when  zymotic  diseases  attack  strong  men  the  risk  is  greater 
than  is  run  by  weaker  frames.  The  end  of  2  by  drowning,  and 
3  by  gunshot  wounds,  show  the  possession  of  energy  and  unsel- 
fish courage,  seldom  the  characteristics  of  a  broken  invalid.  The 
cases  of  the  17  who  do  not  furnish  a  good  account  of  their  health 
are  mostly  somewhat  vague.  Among  so  many,  several  must  have 
hereditary  tendencies  to  disease;  others  say  their  medical  attend- 
ants trace  no  connection  between  their  complaints  and  previous 
muscular  exertion,  and  in  such  a  long  period  as  forty  years  in- 
numerable evil  influences  must  have  been  in  action  ;  while  in  some 
families  it  seems  traditional  always  to  speak  of  their  health  as  only 
moderate,  and  in  others  to  look  back  upon  the  exuberances  of 
their  youth  as  follies.  So  that  17  is  in  fact  a  small  number  to 
be  occasionally  falling  into  the  hands  of  the  physician. 

The  best  test  of  the  value  of  anything  is  to  reduce  it  to  Arabic 
numerals,  and  pounds,  shillings,  and  pence,  as  insurance  offices 
act  by  our  constitutions.  Dr.  Morgan  has  applied  this  test  to  the 

1  Mortality  from  heart  disease  in  Kegistrar-Gen.  Reports  for  10  years  8  per 
cent. ;  in  navy  (1868),  13  per  cent.  ;  among  university  oars,  6£  per  cent. — 
University  Oars,  p.  28. 


ATHLETIC    TRAINING.  157 

294  cases  under  consideration.  According  to  Dr.  Farr's  Life 
Tables  the  expectation  of  life  at  20,  the  average  age  of  university 
oarsmen,  is  40  years.  But  the  survivors  have  still  an  expectation 
of  life  of  14  years  before  them,  and  this  must  be  added  on,  while 
a  calculated  allowance  must  be  made  for  those  who  have  died,  and 
an  estimate  also  deducted  for  the  17  lives  who  reckon  themselves 
damaged.  The  whole  calculation  is  too  long  to  be  gone  into  here, 
but  the  result  is  deckledly  favorable ;  for,  taking  the  experience  as 
it  stands,  the  expectation  of  life  of  each  individual  comes  out,  not 
40,  but  42  years.  So  that  any  insurance  office  which  had  taken 
them  all  at  ordinary  rates  would  be  making  a  handsome  profit 
and  exhibit  a  good  prospective  balance  sheet. 

The  conclusion  is  inevitable  that  for  young  men  in  good  health 
very  severe  athletic  training  strengthens  the  constitution  and 
lengthens  life. 

It  will  of  course  strike  every  one  that  our  example  here  is  taken 
from  a  specially  select  class  of  humanity.  True,  the  fame  of  the 
University  would  not  be  intrusted  to  one  likely  to  break  down 
and  disappoint  his  colleagues.  And  herein  lies  a  great  advantage 
possessed  by  boat-racing  above  other  athletic  sports,  namely,  that 
it  is  to  the  interest  of  all  concerned  to  exclude  from  the  practice 
those  who  are  likely  to  be  injured  by  it.  For  that  some  are  likely 
to  be  injured  is  never  denied ;  and  it  probably  would  be  wise  if 
the  crews,  instead  of  acting  solely  on  their  own  responsibility, 
were  to  insist  on  all  who  joined  them  having  their  fitness  to  un- 
dergo training  tested  by  a  medical  man.  Mr.  Maclaren  says  he 
would  not  allow  any  one  to  pull  in  a  college  boat  whose  chest 
measured  less  than  36  inches,  but  it  is  evident  that  such  an  abso- 
lute rule  must  be  fallacious,  for  the  circumference  of  the  chest 
must  bear  in  a  well-built  man  a  proportion  to  the  height.  The 
better  test  is  the  vital  capacity  or  aerial  contents  of  the  lungs, 
which  Dr.  Hutchinson's  spirometer  and  tables  enable  us  to  measure 
so  accurately. 

Other  forms  of  athletics  have  not  the  same  safeguard.  But  still 
the  good  sense  and  good  feeling  of  Englishmen  is  such,  that  a 
man  very  quickly  finds  out,  or  is  told  by  his  comrades,  if  any- 
thing renders  the  ambition  of  distinction  in  bodily  exercise  unsuit- 
able for  him.  Where  there  is  any  suspicion  of  this  being  the 


158  SPECIAL    DIETETICS    OF    HEALTH. 

case,  parental  authority  may  fairly  be  interposed,  and  the  matter 
settled  in  a  single  medical  examination. 

It  is  not  necessary  that  every  one  who  trains  should  aim  at 
being,  or  even  wish  to  be,  a  distinguished  athlete.  There  are 
modified  forms  or  rather  degrees  of  the  same  process,  which  can- 
not be  trusted  indeed  to  produce  the  extraordinary  development 
of  nerve-force  needful  for  successful  boat-racing  and  the  like,  but 
which  nevertheless  bring  the  body  into  a  state  of  high  health  very 
conducive  to  comfort  and  usefulness. 

The  reading  or  other  intellectual  pursuits  during  training  should 
be  very  moderate  and  (so  to  speak)  mechanical.  Hard  head-work 
should  not  be  carried  on  at  the  same  time  as  hard  training.  It 
should  be  gradually  given  up  at  theTjeginning,  and  resumed  gradu- 
ally after  the  training  has  been  gone  through.  But  there  is  no 
reason  why  the  systematic  cultivation  of  the  mind  and  body 
should  not  alternate  to  their  joint  advantage,  and  indeed  it  evi- 
dently has  done  so  in  the  case  of  many  of  Dr.  Morgan's  heroes, 
whose  names  make  a  conspicuous  appearance  in  the  class  lists  of 
classical  and  mathematical  honors.1 

The  usual  time  allotted  to  training  is  six  weeks.  The  objects 
to  be  attained  in  this  period  may  be  described  as : 

1 .  The  removal  of  superfluous  fat  and  water. 

2.  The  increase  of  contractile  power  in  the  muscles. 

3.  Increased  endurance. 

4.  "  Wind,"  that  is,  a  power  of  breathing  and  circulating  the 

blood  steadily  in  spite  of  exertion. 

The  first  object  is  aimed  at  by  considerably  adding  to  the  daily 
amount  of  nitrogenous,  and  diminishing  farinaceous  and  liquid 
food,  and  providing  that  it  should  be  so  consumed  as  to  be  fully 
digested.  The  second  and  third  are  secured  by  gradually  increas- 
ing the  demands  made  upon  the  muscles  till  they  have  learnt  to 
exert  at  will  all  the  powers  of  which  they  are  capable,  and  for  as 
long  a  period  as  the  natural  structure  of  the  individual  permits. 
Wind  is  improved  by  choosing  as  part  of  the  training  an  exercise, 
such  as  running,  which  can  be  sustained  only  when  the  respiratory 
and  circulating  organs  do  their  duty  fairly. 

1  The  294  include,  at  Oxford  6  firsts  and  11  seconds  in  classics,  1  first  and  2 
seconds  in  mathematics;  at  Cambridge  10  firsts  and  5  seconds  in  classics,  8 
wranglers,  and  21  senior  optimes  in  mathematics. 


ATHLETIC    TRAINING.  159 

The  muscles  of  the  limbs  become  under  a  regimen  of  this  kind 
more  "corky"  or  elastic,  and  more  prominent  when  "put  up"  in 
a  state  of  contraction.  They  improve  in  quality  and  efficiency, 
but  that  they  become  larger  is  extremely  problematical.  Hyper- 
trophied  organs  are  well  known  to  lose  their  shape  and  power;  an 
enlarged  heart,  instead  of  circulating  blood  better,  is  an  incum- 
brance ;  the  muscles  of  the  hollow  viscera,  when  augmented  in 
thickness,  do  not  expel  their  contents  freely ;  an  hypertrophied 
finger,  instead  of  being  stronger  than  the  rest,  is  weaker ;  and  all 
these  are  extremely  liable  to  degenerate  prematurely  and  lose  their 
vitality.  So  that  if  the  muscles  did  by  training  grow  bigger,  as 
reckoned  in  a  state  of  repose,  it  were  a  result  not  at  all  to  be 
desired. 

The  skin  becomes  soft  and  smooth,  and  apparently  more  trans- 
lucent, so  that  the  red  bloom  of  youth  shines  through  it  more 
brilliantly.  The  insensible  perspiration  is  regular  and  even  ;  while 
at  the  same  time  sweating  is  not  so  readily  induced  by  bodily  ex- 
ertion, and  it  is  never  cold  and  sudden,  even  with  mental  excite- 
ment. 

Superfluous  fat  is  removed  from  all  parts  of  the  person,  as  is 
evinced  by  loss  of  weight.  This  requires  to  be  carefully  tested  by 
the  scales  from  time  to  time ;  for  if  the  reduction  be  carried  be- 
yond a  certain  point,  which  varies  in  different  men,  a  loss  of  power 
and  of  endurance  is  felt,  and  probably  future  evil  results  may 
arise.  This  point  is  technically  called  the  "  fighting  weight,"  but 
the  observation  of  it  need  not  be  confined  to  the  pugilistic  trade. 

Training  increases  wonderfully  the  vital  capacity  of  the  chest, 
so  that  a  much  greater  quantity  of  air  can  be  blown  in  and  out  of 
the  lungs  and  with  greater  force  than  previously.  And  this  vital 
capacity  endures  longer  than  any  other  of  the  improvements,  for  I 
have  found  in  examination  for  insurance  several  clients,  formerly  in 
training,  but  who  had  laid  aside  violent  exercise  for  some  years, 
still  retaining  that  mark  of  vigor  to  a  considerable  extent  above  the 
average.  It  is  evidence  of  the  permanent  elasticity  of  the  pulmo- 
nary tissue,  an  efficient  protection  against  asthma,  emphysema, 
and  other  degenerations  of  the  organ  of  breathing. 

Indigestion,  acidity  of  stomach,  sleeplessness,  weariness  of  life, 
nervous  indecision,  dyspeptic  palpitations,  and  irregularity  of  the 


160 


SPECIAL    DIETETICS    OF    HEALTH. 


bowels  disappear  under  training.  But  if  they  exist,  the  regimen 
should  be  entered  upon  with  more  than  usual  caution  and  under 
medical  advice. 

The  following  were  the  systems  pursued  at  the  Universities  in 
1866  as  given  by  Mr.  Maclaren  in  the  Appendix  to  his  "  Training, 
in  Theory  and  Practice,"  and  I  believe  still  carried  on  for  boating- 
men  : 


THE  OXFORD  SYSTEM. 

Summer  Races. 

A  DAY'S  TRAINING. 


Kise  about  7  A.M. 


Exercise 

Breakfast,  8.30.. 


Exercise  (forenoon). 
Dinner,  2  P.M 


Exercise.. 


Supper,  8.30  or  9. 


Bed  about  10. 


A  short  walk  or  run... 
Meat,  beef,  or  mutton. 

Bread,  or  toast  dry 

Tea 


None. 

Meat,  much  the  same  as  for 
breakfast. 

Bread 

Vegetables  (none  allowed) 

Beer,  one  pint. 

About  five  o'clock,  start  for  the 
river,  and  row  twice  over  the 
course,1  "  the  speed  increas- 
ing with  the  strength  of  the 
crew." 

Meat,  cold. 

Bread;  perhaps  a  jelly  or 
watercresses.  • 

Beer,  one  pint. 


So  as  to  be  in  chapel,  but  early 
rising  not  compulsory. 

Not  compulsory. 

Underdone. 

The  crust  only  recommended. 

As  little  as  possible  recom- 
mended. 


Crust  only  recommended. 
A  rule,  however,  not  always 
adhered  to. 


Summary. 

Sleep About  nine  hours. 

Exercise Walking  and  rowing  about  one  hour. 

Diet Very  limited. 


1  The  length  of  the  course  is  nearly  a  mile  and  one-eighth. 


ATHLETIC    TRAINING. 


161 


Winter  Races. 
A  DAY'S  TRAINING. 


Kiso  about  7.30  A.M 



Hrt-akl'iist,  '.I 

Kxrrrist!  (forenoon) 

Uiurhron  about  1  P.M.. 


Exercise.. 


Dinner  at  five,  in  Hall.. 


Bed,  10.30. 


As  for  summer  races. 

None. 

Bread  or  a  sandwich. 

Beer,  half  a  pint. 

About  two  o'clock  start  for  the 
river,  and  row  twice  over 
the  course 


Meat  as  for  summer  races. 

Bread. 

Vegetables    as    for    summer 

races. 

Pudding  (rice),  a  jelly. 
Beer,  half  a  pint. 


Early  rising  not  compulsory. 
Not  compulsory. 


Crews  are  taken  over  the  long 
course  to  Nuneham,  perhaps 
twice  during  their  practice. 


N.B. — It  is  particularly  impressed  on  men  in  training  that  as  little  liquid  as  possible  is  to  be 
drunk,  water  being  strictly  forbidden. 

Summary. 

Exercise'.!."  \  As  for  summer  races- 

Diet Nearly  the  same  as  for  summer  races;  luncheon  being  about  equivalent  to 

supper. 

THE  CAMBRIDGE  SYSTEM. 

Summer  Races. 
A  DAY'S  TRAINING. 


Rise  at  7  A.M. 
Exercise 


Breakfast,  8.30.. 


Exercise  (forenoon). 
Dinner  about  2  P.M.. 


Exercise 

Supper  about  8.30  or  9. 

Bed  at  10. 


Run  100  or  200  yards  "as  fast 
as  possible" 


Meat,  beef,  or  mutton. 

Toast  dry. 

Tea,  two  cups,  or  towards  the 
end  of  training  a  cup  and  a 
half  only.  Watercresses  oc- 
casionally. 

None. 

Meat,  beef  or  mutton. 

Bread. 

Vegetables,  potatoes, greens.... 

Beer,  one  pint. 

Dessert.— Oranges  or  biscuits, 
or  figs;  wine,  two  glasses. 

About  5.30  start  for  the  river, 
and  row  to  the  starting-post 
and  back. 

Meat,  cold. 

Bread. 

Vegetables — lettuce  or  water- 
cresses. 

Beer,  one  pint. 


The  old  system  of  running  a 
mile  or  so  before  breakfast 
is  fast  going  out,  except  in 
the  case  of  men  who  want  to 
get  a  good  deal  of  flesh  off. 

Underdone. 


Some  colleges  have  baked  ap- 
ples, or  jellies,  or  rice  pud- 
dings. 


Summary. 

Sleep Nine  hours. 

Exercise About  an  hour  and  a  quarter.1 

Diet Limited. 

N.B. — On  Sundays  men  generally  take  a  long  walk  of  five  or  six  miles. 

1  The  course  is  a  trifle  longer  than  at  Oxford,  and  there  is  a  pull  of  ll/£  mile  to  get  to  it. 

11 


162  SPECIAL    DIETETICS    OF    HEALTH. 

Winter  Races. 

A  DAY'S  TRAINING. 
Kife  about  7  A.M. 

Exercise,     ....     As  for  summer  races.  » 

Breakfast,  8.30,  "  " 

Exercise  (forenoon),  .         .     None. 
Luncheon  about  1  P.M.,      .     A  little  cold  meat. 
Bread. 

Beer,  half  a  pint,  or  biscuit  with  a  glass 
of  sherry ;  perhaps  the  yolk  of  an  egg 
in  the  sherry. 
Exercise,     ....     About  2  o'clock  start  for  the  river  and 

row  over  the  course  and  back. 
Dinner  about  5  or  6,  .         .     As  for  summer  races. 
Bed  about  10. 

Summary. 

"'.         '         'I     Same  as  for  summer  races. 
Exercise,    .         .  J 

Diet,  .         .         Nearly  the  same  as  for  summer  races,  luncheon 

being  about  equal  to  supper. 

There  is  nothing  very  terrible  in  the  discipline  here  enforced, 
while  some  latitude  is  permitted  to  peculiarities  and  a  wish  for 
variety,  and  plenty  of  time  is  left  for  business  and  social  inter- 
course. Other  plans  are  objectionable  from  involving,  without 
any  resulting  advantage  that  I  can  see,  a  complete  bouleversement 
of  the  usual  times  and  seasons  adopted  by  the  upper  and  middle 
classes  in  this  country.  For  example,  in  Clasper's  method  dinner 
is  to  be  at  12  o'clock,  with  nothing  more  than  a  very  light  tea 
afterwards  and  no  supper.  Then  a  country  walk  of  four  or  five 
miles  is  to  be  taken  before  breakfast,  and  a  couple  of  hours'  row 
after,  and  another  hard  row  between  dinner  and  tea.1  "  Stone- 
henge"  again  requires  the  time  between  breakfast  and  dinner  to 
be  spent  entirely  in  billiards,  skittles,  quoits,  rowing,  and  running, 
in  spite  of  another  hour's  row  being  prescribed  at  6  P.M.  He  also 
requires  the  aspirant  to  athletic  honors  to  sleep  between  ten  and 
eleven  hours.2  Only  professionals  are  likely  to  carry  out  such 
rules.  The  most  doubtful  point  which  a  physiological  critic 

1  Quoted  by  Mr.  Maclaren  from  Eowing  Almanac  for  1863. 

2  Article  "  Boat-racing"  in  British  Eural  Sports,  1861. 


ATHLETIC    TRAINING.  163 

would  lay  his  finger  upon  is  the  exaggerated  abstinence  from  fluids 
recommended  in  the  Oxford  scale.  The  use  of  water  to  the  extent 
of  the  thirst  felt  by  the  individual  promotes  the  vital  renewal  of 
the  skin,  kidneys,  and  digestive  viscera,  and  cannot  be  injurious. 
But  it  should  not  be  very  cold,  or  swallowed  in  great  quantities 
at  once  on  a  full  stomach,  or  after  extraordinary  exertion,  lest  it 
should  lower  too  much  the  bodily  temperature.  If  the  mouth  be 
first  rinsed  out,  and  the  draught  imbibed  calmly  and  deliberately, 
it  quenches  thirst  much  better  than  when  rudely  gulped,  and  is 
not  likely  to  be  taken  in  excess. 

It  is  probably  not  necessary  in  the  present  day  to  enforce  suffi- 
cient tubbing  to  keep  the  skin  clean  and  fresh.  It  is  in  fact  more 
necessary  to  deprecate  excess  in  the  use  of  cold  water.  If  a  bath 
is  taken  between  exercise  and  a  meal,  the  chill  should  at  least  be 
taken  off,  for  there  has  been  a  considerable  loss  of  temperature  by 
perspiration,  and  more  cannot  be  afforded.  The  use  of  a  cold 
bath  is  to  contract  the  cutaneous  arteries,  and  by  throwing  the 
blood  back  suddenly  on  the  heart  and  lungs  to  stimulate  them  to 
increased  reaction,  so  that  the  living  stream  should  flow  vigorously 
to  the  extremities.  If  the  skin  is  already  pale  and  cool,  as  after 
exertion,  it  shows  that  they  are  already  contracted  and  rather  de- 
mand relaxation.  The  time  for  a  cold  bath  is  when  the  skin  is 
full-colored,  dry,  and  warm. 

Nothing  is  said  here  of  the  training  of  jockeys  and  others  whose 
object  is  to  reduce  their  weight  to  its  extreme  minimum  irrespec- 
tively of  augmenting  the  strength,  as  that  cannot  be  recommended 
on  the  score  of  attaining  high  health,  nor  is  it  likely  to  be  volun- 
tarily undertaken  by  healthy  persons. 

The  university  scheme  may  fairly  be  accepted  as  a  typical  regi- 
men for  fully  developing  a  young  man's  corporeal  powers  to  fulfil 
the  demands  of  an  extraordinary  exertion.  It  is  a  standard  which 
we  may  modify  according  to  the  circumstances  for  which  the  train- 
ing is  required. 

Thus,  for  instance,  in  training  for  the  moors  or  for  the  thor- 
ough enjoyment  of  partridge  shooting,  the  reduction  of  fat  should 
not  be  carried  so  far,  as  steady  endurance  for  many  days  together 
is  required,  and  a  treasure  of  adipose  tissue  as  a  basis  of  molecu- 
lar growth  must  be  retained.  Butler  may  be  allowed,  milk  in  the 
tea,  and  eggs  as  a  change  for  the  lean  meat  at  breakfast.  For 


164  SPECIAL    DIETETICS    OF    HEALTH. 

men  who  have  got  into  middle  life  running  is  needlessly  trouble- 
some, and  quick  walking  may  be  substituted  both  for  that  and  for 
the  rapid  rowing.  Nevertheless  the  times  should  be  observed 
strictly,  and  the  amount  of  the  walking  may  be  raised  gradually 
up  to  that  wanted  for  the  day's  sport.  It  will  be  necessary,  how- 
ever, to  allot  to  exercise  a  considerable  longer  time  than  is  al- 
lotted in  the  college  training  scheme.  For  it  must  be  remembered 
that  quick  rowing  for  an  hour  is  a  violent  exertion  and  takes 
more  out  of  a  man,  and  practices  the  wind  better  than  four  hours' 
walking.  The  chest  may  be  expanded  by  the  employment  of 
light  dumb-bells  or  clubs  (if  heavy  they  strain  the  muscles). 
And  the  healthy  action  of  the  skin  should  be  promoted  by  fric- 
tion with  rough  towels  and  horse-hair  gloves.  The  time  of  the 
training  should  not  be  so  long  as  six  weeks,  for  in  point  of  fact  it 
is  carried  on  by  the  exercise  of  the  sport,  and  if  such  an  extended 
period  as  used  for  boat-racing  is  adopted,  there  is  a  risk  of  over- 
doing the  discipline.  A  fortnight  is  quite  enough  for  the  pur- 
pose. 

To  those  of  our  countrymen  and  women  who  have  not  the  op- 
portunity or  inclination  for  spending  their  holiday  in  what  is 
commonly  called  "sport,"  the  fashion  of  mountaineering  is  a  great 
boon.  And  even  sportsmen,  during  the  dead  season  when  there 
is  nothing  to  be  killed,  experience  a  compensation  in  finding  some- 
thing to  go  up.  But  a  great  deal  of  the  advantage  of  the  relaxa- 
tion is  often  lost  by  not  being  already  in  training.  At  least  the 
first  week  is  wasted  in  getting  into  condition,  and  is  a  period  of  as 
much  pain  as  pleasure.  This  may  be  obviated  by  a  gradual  adop- 
tion of  the  diet  and  discipline,  modified  as  above,  for  a  week  or 
ten  days  before  starting. 

The  pain  in  the  back  and  sides  which  hunting  men  often  ex- 
perience at  the  commencement  of  the  season,  arises  usually  from 
imperfect  expansion  of  the  lungs  in  ordinary  breathing.  The 
muscles  of  the  trunk  are  strained  by  the  effort  of  expiration  during 
exercise.  The  inconvenience  may  be  prevented  by  a  partial  train- 
ing. The  diet  should  be  drier  than  usual,  and  all  sweets  and 
pastry  left  off,  the  chest  expanded  by  dumb-bells  and  running, 
and  the  habit  acquired  of  keeping  the  lungs  as  full  of  air  as  possi- 
ble. Women,  being  weaker-muscled  than  men,  often  feel  this  to 
the  extent  of  giving  up  altogether  the  healthy  amusement  of  rid- 


ATHLETIC    TRAINING.  165 

ing.  The  simple  adoption  of  modified  training  gets  over  the  diffi- 
culty. The  dumb-bells  should  be  used  in  private  before  putting 
on  the  stays,  and  particular  attention  paid  to  the  injunction  of 
thoroughly  inflating  the  lungs. 

It  used  to  be  the  custom  before  the  commencement  of  a  course 
of  training  to  be  bled,  purged,  and  sweated.  I  do  not  think  it  of 
any  service,  and  it  induces  constipation  of  the  bowels,  besides 
being  weakening.  Some  take  Turkish  baths  during  athletic  train- 
ing, but  they  appear  to  derange  the  daily  discipline,  unless  they 
are  taken  every  day,  which  would  be  a  decided  excess. 

Ladies  who  are  going  to  try  training  for  athletic  purposes,  will 
find  some  attention  to  costume  expedient.  If  stays  are  worn  (and 
there  is  no  objection  to  them  if  well-fitted  and  not  too  tight)  they 
should  have  no  shoulder-straps.  The  drawers  should  not  be  tied 
below  the  knee.  The  best  defences  to  the  lower  extremities  in 
rough  ground  are  stout  Alpine  shoes,  and  light  leathern  gaiters 
half-way  up  to  the  knee  supporting  the  long  socks  without  garters. 
A  light  woollen  jersey  should  be  worn  next  the  skin.  The  skirt 
of  the  dress  should  be  short  and  narrow,  and  the  best  materials 
are  serge  and  homespun.  Besides  these  the  less  drapery  is  worn 
the  better. 

Training  is  sometimes  carried  too  far — the  men  describe  them- 
selves as  "  fallen  to  pieces."  The  most  peculiar  symptom  is  an 
occasional  attack  of  sudden  loss  of  power,  after  exertion.  It  is 
sometimes  called  "  fainting,"  but  there  is  no  loss  ef  sense,  as  in 
that  state,  and  is  quickly  relieved  by  liquid  food.  It  is  patho- 
logically an  acute  and  temporary  form  of  that  consequence  of 
overstrained  muscle  which  constitutes  "  writer's,"  "  turner's,"  and 
"blacksmith's"  palsy.  The  obvious  remedy  is  to  leave  off  train- 
ing. 

The  exercise  and  excitement  combined  of  practicing  for  boat- 
racing  will  sometimes  induce  recurrent  palpitations  of  the  heart. 
A  physician  should  immediately  be  consulted  as  to  whether  this 
arises  from  an  organic  cause ;  if  it  does  not,  rest  and  a  dose  or  two 
of  purgative  medicine  should  be  taken  before  a  resumption  of 
training  ;  and  it  will  be  well  to  add  a  moderate  quantity  of  port 
wine  to  the  dietary.  If  the  palpitations  still  return,  there  is  no 
help  for  it  but  to  give  in,  and  acknowledge  that  nature  has  not 
cut  out  every  one  to  the  pattern  of  an  athlete. 


166  SPECIAL    DIETETICS    OF    HEALTH. 

The  unusual  strain  on  the  skin  sometimes  induces  boils.  The 
best  preventive  is  to  anoint  the  skin  with  a  little  sweet  oil  after 
the  morning  bath.  If  a  spot  gets  tender  and  red,  threatening  a 
boil,  touch  it  lightly  every  day  with  nitrate  of  silver,  and  give 
bark  and  chlorate  of  potash  twice  a  day  in  the  usual  doses.  (De- 
coct. Cinch.,  fl.  5  j ;  Pot.  Chlor.,  gr.  xv.) 

A  modification  of  training  of  considerable  importance  to  notice 
is  that  which  contemplates  the  reduction  of  superfluous  plumpness, 
either  for  the  sake  of  the  appearance  or  the  general  comfort  of  the 
sufferer.  There  may  be  a  question  whether  the  health  is  benefited 
by  it,  unless  the  previous  diet  or  habits  had  been  irrational  and 
improper. 

Corpulence  usually  prevents  exercise  being  taken  to  a  sufficient 
extent  for  confidence  to  be  placed  in  it  as  an  efficient  part  of  the 
treatment,  and  therefore  the  diet  becomes  a  more  essential  feature. 
If  an  exhausting  amount  of  bodily  exertion  be  persisted  in,  the 
digestion  of  meat  is  interfered  with,  while  at  the  same  time  the 
absorption  of  such  fat  as  unavoidably  exists  in  the  food  still  goes 
on,  so  that  the  muscles  and  nerves  lose  strength  while  the  adipose 
tissue  grows.  Besides  this,  if  by  violent  means  the  weight  is 
worked  down,  those  violent  means  must  be  continuously  sustained 
to  keep  it  down  ;  and  if  they  are  neglected  in  consequence  of  more 
absorbing  occupations,  the  inconvenience  rapidly  increases  to  a 
greater  degree  than  ever.  Many  uncomfortably  stout  persons  are 
very  active  irt  mind  and  body,  and  really  could  not  add  to  their 
muscular  discipline  without  risk  of  injury. 

The  following  may  be  taken  as  a  modification  of  the  training 
regimen  suitable  for  the  reduction  of  corpulence. 

Day's  regimen  for  a  three  weeks'  course. 

Rise  at  7.  Rub  the  body  well  with  horse-hair  gloves,  have  a 
cold  bath,  take  a  short  turn  in  the  open  air.  Breakfast  (alone)  at 
8  or  8.30,  on  the  lean  of  beef  or  mutton,  cutting  off  the  fat  and 
skin,  dry  toast,  or  biscuit,  or  oat-cake,  a  tumbler  of  claret  and 
water  or  tea  without  milk  or  sugar,  or  made  in  the  Russian  way 
with  a  slice  of  lemon.  Luncheon  at  1  on  bread  or  biscuit,  Dutch 
cheese,  salad,  watercresses,  or  roasted  apples  (without  sugar  or 
cream),  hung  beef,  or  anchovies,  or  red  herring  or  olives,  and 


ATHLETIC    TRAINING.  167 

such-likc  relishes.  Drink,  after  eating,  claret  and  water,  or  un- 
sweetened lemonade,  or  plain  water,  in  moderation.  Dinner  at 
any  convenient  hour.  Take  no  soup,  fish,  or  pastry,  but  plain 
meat,  of  any  kind  except  pork,  rejecting  the  fat  and  skin.  Spin- 
ach, French  beans,  or  any  other  green  vegetable  may  be  taken, 
but  no  potatoes,  made  dishes,  or  pastry.  A  jelly  or  a  lemon-water 
ice  or  a  roast  apple  must  suffice  for  sweets  and  dessert.  Claret 
and  water  at  dinner,  and  one  glass  of  sherry  or  Madeira  after- 
wards. 

Between  each  meal  exercise,  as  a  rule,  in  the  open  air,  to  the 
extent  of  inducing  perspiration,  must  be  taken.  Running,  when 
practicable,  is  the  best  form  in  which  to  take  it. 

The  number  of  hours  alotted  to  bed  in  the  University  schemes 
is  too  much  for  the  purpose  now  proposed.  Seven  is  quite  enough, 
and  if  the  person  under  training  wants  to  retire  before  12  o'clock, 
he  ought  to  be  astir  before  the  time  mentioned  above.  There  are 
few  things  more  weakening  than  remaining  in  bed,  or  even  in  a 
bedroom  which  has  been  closed  during  the  night,  when  thoroughly 
woke  up.  During  sleep  little  air  is  required ;  we  all  know  the 
slow  shallow  breathing  of  a  sleeper,  by  which  the  respiratory 
muscles  are  rested.  Beasts  get  enough  oxygen  in  their  narrow 
dens,  and  man  in  his  fusty  garret.  But  once  awake,  both  expand 
their  lungs  fully,  instinctively  demand  fresh  air,  and  suffer  from 
the  want  of  it  more  at  that  hour  than  at  any  other  time  during 
the  day.  If  a  Sybarite  must  indulge  in  the  horizontal  position, 
let  him  at  all  events  open  his  window  and  take  his  tub  before  he 
does  so. 

If  good  Turkish  baths  are  accessible,  four  or  five  may  be  used 
in  place  of  exercise  between  meals  at  intervals  during  the  reduc- 
tive training.  And  thorough  shampooing  by  an  experienced 
hand  should  not  be  omitted. 

The  weight  is  to  be  accurately  recorded  at  the  commencement 
and  every  four  days,  so  that  its  loss  may  not  be  too  rapid  or  ex- 
cessive. Six  or  seven  pounds  is  usually  as  much  as  it  is  prudent 
to  lose  during  the  fortnight. 

A  more  important  sign  of  improvement  is  increased  vital  ca- 
pacity of  the  lungs  as  measured  by  the  spirometer. 

After  the  fortnight's  course  the  severe  parts  of  the  discipline 


168  SPECIAL    DIETETICS    OF    HEALTH. 

may  be  gradually  omitted,  but  it  is  strongly  recommended  to 
modify  the  general  habits  in  accordance  with  the  principle  of 
taking  as  small  a  quantity  as  possible  of  fat  and  sugar  and  of  the 
substances  which  form  fat  and  sugar,  and  sustaining  the  respira- 
tory function.  Fat  meat,  rich  milk,  butter,  malt  liquors,  pastry, 
starchy  foods  (such  as  potatoes,  puddings),  sweet  vegetables  (such 
as  parsnips  and  beet-root),  sweet  wines  (such  as  champagne)  should 
be  taken  only  most  sparingly.  An  appetite  should  be  acquired  for 
lean  meat,  especially  for  beef,  mutton,  and  venison,  for  game  and 
poultry,  for  plain  boiled  fish,  for  poor  new  cheese,  for  green  vege- 
tables and  salads,  summer  fruits,  oranges,  lemons  and  pomegran- 
ates, almonds  (fried  and  sprinkled  with  salt  and  cayenne),  roast 
apples,  olives,  lemonade,  buttermilk,  claret,  and  hock.  Aerated 
bread,  captain's  biscuits,  and  dried  toast,  all  in  moderation,  are 
the  most  appropriate  form  of  flour. 

Excessive  stoutness  amounts  to  a  disease ;  it  is  a  true  hypertro- 
phy of  the  adipose  tissue,  and  it  is  not  capable  of  removal  by  the 
means  mentioned  above,  though  in  cases  where  it  has  been  aug- 
mented by  a  previously  inconsiderate  diet,  it  may  be  considerably 
reduced.  The  subject  will  be  resumed  when  the  dietetics  of  dis- 
ease are  under  consideration. 


HINTS    FOR    TRAVEL.  169 


CHAPTER  VII. 

HINTS    FOR    HEALTHY   TRAVELLERS. 

A  MODERATE  course  of  training  is  a  good  preparation  previous 
to  travelling  for  business  or  pleasure,  or  for  active  military  ser- 
vice ;  but  it  is  well  in  these  cases  not  to  let  the  dietary  become 
habitually  too  limited  or  careful.  It  is  convenient  to  be  able  to 
eat  without  repugnance  any  food  capable  of  supplying  nutriment, 
even  though  dirty,  ill-cooked,  or  of  strange  nature.  There  is 
often  a  choice  only  between  that  and  going  without. 

When  actually  on  a  carriage  or  railway  journey  it  is  unwise  to 
make  large  meals.  They  are  sure  to  be  swallowed  in  a  hurried 
manner,  and  in  a  state  of  heat  and  excitement  very  unfavorable 
to  digestion.  The  best  way  is  to  make  no  meal  at  all  till  the 
journey  is  over,  but  to  carry  a  supply  of  cold  provisions,  bread, 
eggs,  chickens,  game,  sandwiches,  Cornish  pasties,  almonds, 
oranges,  captain's  biscuits,  water,  and  sound  red  wine,  or  cold 
tea,  sufficient  to  stay  the  appetites  of  the  party,  and  let  a  small 
quantity  be  taken  every  two  or  three  hours. 

If  this  plan  be  adopted,  not  only  is  activity  of  mind  and  body 
preserved,  but  that  heat  and  swelling  of  the  legs  which  so  often 
concludes  a  long  day's  journey  is  avoided.  Attention  to  the  matter 
is  particularly  necessary  when  the  journey  continues  all  night, 
and  for  several  days  in  succession,  since  varicose  veins  and  per- 
manent thickening  of  the  ankles  have  sometimes  resulted  from 
this  exertion  being  combined  with  too  long  fasts  and  hurried  re- 
pletion at  protracted  intervals. 

The  less  stimulant  a  traveller  consumes  before  he  arrives  at  his 
sleeping-place  the  better.  Then  the  habitual  allowance  is  of  ad- 
vantage. If  a  good  wine  is  made  in  the  country  he  is  passing 
through,  he  will  probably  prefer  to  fare  the  same  as  his  hosts;  if 
not,  Bordeaux  and  Burgundy  are  the  best  vintages  when  procura- 
ble, and  Marsala  in  Italy. 

In  France  and  Germany  very  good  local  beer  is  to  be  obtained, 


170  SPECIAL    DIETETICS    OF    HEALTH. 

but  landlords  seem  to  object  to  its  being  publicly  used  as  a  bev- 
erage. We  ought  to  insist  on  our  rights  as  tourists  on  this  point. 
In  apple  districts,  cider  is  usually  placed  on  the  table  gratis,  and 
makes  a  good  substitute  for  doubtful  water. 

The  water  is  very  apt  to  disagree  with  tourists,  especially  in 
volcanic,  basaltic,  mountainous,  and  marshy  districts.  A  pocket 
filter  is  a  great  protection,  and  boiling  the  water  makes  all  organic 
matters  harmless,  and  gets  rid  of  the  greater  part  of  the  lime. 
But  neither  of  these  expedients  removes  the  neutral  and  alkaline 
salts,  which  will  sometimes  act  as  a  purgative. 

In  almost  all  country  places  out  of  England  it  is  impossible  to 
avoid  the  greasy  dishes  which  are  apparently  preferred  by  all  ex- 
cept our  own  countrymen.  And  a  frequent  consequence  is  rancid 
indigestion,  with  nauseous  taste  in  the  mouth,  and  flatulence  or 
diarrhcea.  A  few  drops  of  vinegar  or  lemon-juice,  and  a  little 
cayenne  pepper  in  the  plate  are  the  readiest  correctives. 

Another  article  of  cuisine  that  offends  the  bowels,  if  not  the 
palate,  of  Britons,  is  garlic.  Not  uncommonly  in  southern  climes 
an  egg  with  the  shell  on  is  the  only  procurable  animal  food  with- 
out garlic  in  it.  Flatulence  and  looseness  are  the  frequent  results. 
Bouilli,  with  its  accompaniments  of  mustard  sauce  and  water- 
melon, is  the  safest  resource,  and  not  an  unpleasant  one,  after  a 
little  education. 

By  special  favor  potatoes  can  usually  be  obtained  boiled  with 
their  jackets  on  (en  chemise),  but  unless  asked  for  are  seldom  pro- 
duced. 

Raw  ham,  which  some  persons  seem  to  find  a  luxury,  will  be 
avoided  by  all  sane  travellers  who  have  heard  of  the  frequency 
with  which  it  is  infested  with  live  measle-worm  and  trichina 
spiralis. 

It  is  a  great  convenience  to  be  able  to  eat  olive  oil,  which  is 
much  wholesomer  than  doubtful  butter  in  warm  climates ;  and 
those  who  care  for  the  future  comfort  of  their  sons  and  daughters 
will  accustom  them  to  the  taste  in  youth,  instead  of  encouraging 
a  daintiness  in  this  particular,  as  I  have  seen  done.  Repugnance 
to  the  flavor  of  goat's  milk  ought  to  be  got  over  by  those  who 
ever  intend  to  frequent  lands  where  the  pasture  will  not  support 
cows.  A  preference  also  for  boiled  milk,  or  milk  that  has  been 
boiled,  is  a  safe  fancy  to  indulge,  where  you  are  not  acquainted 


HINTS    FOR    TRAVEL.  171 

with  the  yielder  of  the  liquid,  especially  when  typhoid  fever  is 
rife.  Irish  peasants  scarcely  ever  drink  it  raw. 

On  the  Continent  the  household  bread  is  usually  unwholesome 
and  nasty,  and  captain's  biscuits  are  never  to  be  obtained.  It  is 
prudent  to  carry  a  store  of  them  for  use  whenever  the  staff  of  life 
is  especially  abominable.  This  does  not  apply  to  Spain,  where 
delicious  white,  firm,  fine-grained  bread  can  be  procured  in  places 
where  it  is  the  only  thing  eatable  by  a  dainty  person. 

A  small  tin  of  the  usual  tea  employed  at  home  is  well  worth 
the  space  it  occupies. 

"  Liebig"  is  procurable  in  almost  every  civilized  town,  and  a 
small  store  may  be  laid  in  when  rough  cookery  is  expected. 

A  knowledge  of  simple  methods  of  preparing  food  is  often  a 
great  comfort  to  a  traveller.  A  friend  of  mine  was  once  consid- 
erably nonplussed  in  Norway,  after  he  had  bargained  for  some 
lamb,  by  having  the  animal  handed  over  to  him  bleating,  with  a 
request  that  he  would  return  the  skin  in  the  evening.  The  task 
was  accomplished  under  difficulties,  but  the  details  are  unpleasant. 
This  is  an  extreme  contingency,  which  need  not  be  provided 
against  by  all  vacation  barristers  acquiring  the  art  of  butchering ; 
but  still  it  is  worth  while  to  learn  in  your  own  kitchen  how  to 
prepare  an  omelet,  fry  fish,  eggs  and  ham,  cut  and  grill  a  steak 
off  a  joint,  boil  and  fry  potatoes,  scrabble  eggs,  mull  wine  (if  it 
happens  to  be  sour),  boil  coffee,  make  "  Liebig  "  into  good  soup, 
etc.  These  accomplishments  may  be  brought  into  play  without 
wandering  very  far  from  home  ;  and  it  is  astonishing  how  popular 
they  render  those  sometimes  troublesome  fellow-travellers,  the 
ladies  of  the  party. 

Travellers,  otherwise  strong,  are  apt  to  get  diarrhoea  occasion- 
ally, partly  from  the  unaccustomed  diet,  partly  from  the  water, 
but  very  frequently  also  from  the  pestiferous  state  of  the  provi- 
sions for  daily  retirement  in  Continental  inns.  It  is  worth  know- 
ing that  in  many  places,  especially  in  France,  the  landlady  has  a 
small  private  establishment  of  her  own,  quite  unobjectionable,  of 
which  she  will  lend  the  key  to  favored  guests,  especially  Britons. 
In  country  places  gentlemen  will  do  well  to  worship  Cloacina  sub 
Jove.  For  this  sort  of  mild  dysentery  will  keep  recurring  again 
and  again,  easier  induced  by  having  occurred  before ;  and  not  un- 


172  SPECIAL    DIETETICS    OF    HEALTH. 

frequently  it  will  leave  traces  of  imperfect  digestion  in  the  bowels 
for  weeks  after  returning  home. 

As  a  provision  against  accidental  diarrhrea  it  is  wise  to  be  pre- 
pared with  some  chalk  and  opium  powders  (Pulvis  Oretce  aromati- 
cus  cum  Opio,  Pharm.  Brit.}  made  up  in  20-grain  packets,  in 
thin  gutta  percha  or  oil  silk,  to  keep  them  dry.  In  northerly  lat- 
itudes half  a  packet,  containing  J  grain  of  opium,  can  be  taken 
after  each  relaxation.  But  in  warm  countries  a  more  efficient,  at 
least  a  more  permanently  efficient  remedy  is  to  be  found  in  lemon- 
juice.  The  patient  should  lie  down  flat,  and  keep  sipping  a  mix- 
ture of  half  and  half  lemon-juice  and  water,  or  simply  sucking 
lemons,  till  the  symptoms  have  ceased,  which  will  soon  be  the 
case.  The  nausea  and  narcotism  induced  by  opium  are  thus 
avoided,  and  there  is  no  danger  in  taking  an  excess  of  the  fruit. 
It  is  a  good  thing  to  get  accustomed  to  the  acidity  of  the  flavor, 
for  there  is  nothing  so  wholesome  and  convenient  as  a  drink. 

Travellers  in  countries  where  the  atmosphere  is  very  dry,  as  in 
the  vicinity  of  the  Mediterranean,  sometimes  lose  their  appetite 
for  breakfast  from  want  of  sleep.  This  inconvenience  may  be 
overcome  by  soaking  a  sheet  or  some  towels  in  water  and  spread- 
ing them  out  on  the  floor  of  the  bed-room,  so  as  to  diffuse  moist- 
ure through  the  air  breathed  during  sleep. 

Long  days'  rides,  especially  in  the  heat,  are  liable  to  bring  on 
an  inert  or  semi-paralyzed  condition  of  the  stomach,  so  that  if  a  full 
meal  be  taken  immediately  it  remains  undigested,  and  is  frequently 
thrown  up  again.  This  may  be  prevented  by  a  rest  and  a  hot 
bath  between  getting  out  of  the  saddle  and  sitting  down  to  table. 
If  these  cannot  be  had,  it  will  be  best  to  eat  something  very  light, 
such  as  soup,  eggs,  bread,  and  in  small  quantities,  and  to  make  up 
the  deficiency  next  day  at  breakfast  and  luncheon,  which  should 
be  always  the  solidest  meals  in  journeys  of  this  sort. 

Boils  are  sometimes  very  troublesome  to  equestrians.  A  small 
piece  of  nitrate  of  silver  ought  to  be  carried  in  the  baggage,  and 
on  the  first  tenderness,  redness,  and  hardness  of  the  skin,  the  part 
should  be  damped  and  the  caustic  crossed  twice  over  it.  The  ob- 
ject is  not  to  make  the  cuticle  rise  in  a  blister,  but  to  contract  and 
render  insensitive  the  cutis.  This  will  usually  cause  the  boil  to 
die  away. 

Pedestrians  will  do  well  to  make  a  good  breakfast  before  start- 


HINTS    FOR    TRAVEL.  173 

ing,  however  early  the  hour  may  be.  If  tea  or  coffee  are  not 
relished  on  account  of  the  time  being  so  unusual,  beef  tea  or  soup 
will  be  found  an  excellent  substitute.  If  prepared  over  night, 
they  are  easily  warmed  up  in  the  morning. 

Advantage  should  be  seized  of  every  day  of  rest  to  feed  well, 
and  fatten  up  as  much  as  possible.  This  does  not  put  the  body 
out  of  training,  but  in  fact  keeps  it  in  a  condition  fit  for  continu- 
ous exertion. 

Beer,  wine,  and  spirits  should  be  avoided  altogether  during  the 
day's  work,  but  water,  cold  tea,  or  lemonade  may  be  drunk  ac- 
cording to  thirst.  An  occasional  pipe  of  tobacco  seems  to  palliate 
better  than  anything  else  that  dryness  of  mouth  which  constitutes 
false  thirst.  This  false  thirst  naturally  arises  during  exercise  in  a 
rarefied  air,  but  in  mountainous  places  it  is  often  aggravated  very 
much  by  eating  snow  or  ice.  Spring-water,  though  scarcely  over 
the  freezing-point,  does  not  seem  to  have  the  same  unpleasant 
effect. 

Sea-voyages  have  a  powerful  curative  effect  on  some  invalids, 
but  they  do  not  generally  bring  healthy  persons  into  very  good 
condition.  If  it  is  calm,  landsmen  overeat  themselves,  take  too 
little  exercise,  sleep  badly,  and  get  their  bowels  constipated.  If  it 
is  rough,  they  suffer  from  sea-sickness  and  the  increased  badness 
of  ventilation  below.  The  remedies  for  these  things,  so  far  as 
they  are  remediable,  are  obvious. 

Short  sea-voyages  do  nobody  any  good,  and  a  few  people  a 
great  deal  of  harm.  They  are  an  inevitable  evil  for  all  islanders 
who  wish  to  enlarge  their  ideas.  Sea-sickness  may,  however,  be 
considerably  palliated  by  rational  preparation  for  it.  In  the  first 
place  care  should  be  taken  to  finish  all  preliminary  arrangements 
as  long  before  starting  as  you  can,  so  that  a  day  or  two  may  be 
given  to  rest  and  a  temperance  somewhat  more  than  usual.  If 
the  eyes  or  skin  are  dingy  and  yellow,  take  a  purge  of  aloes  or 
taraxacum.  Go  on  board  in  good  time,  so  as  to  secure  a  comforta- 
ble post.  If  it  is  evidently  going  to  be  rough,  go  below  and  lie 
down  immediately.  If  you  remain  on  deck,  be  very  warmly 
clothed,  and  especially  let  no  chill  affect  the  abdomen  or  back. 
If  the  stomach  feels  empty,  and  still  more,  if  any  dry  retching 
occurs,  take  bottled  porter  and  biscuit  spread  with  a  little  butter 
and  cayenne  pepper — which  last  article,  by  the  way,  amply  repays 


174  SPECIAL    DIETETICS    OF    HEALTH. 

the  space  it  will  occupy  in  a  traveller's  pocket  throughout  a  jour- 
ney, so  useful  is  it  on  all  occasions.  Nutritious  food  should  be 
taken  when  practicable,  but  loading  the  stomach  with  trash  brings 
on  sickness;  though  truly  enough  it  facilitates  the  process  of 
vomiting,  and  prevents  the  regurgitation  of  bile,  which  is  always 
peculiarly  painful  after  dry  retching. 

If  the  voyage  is  by  night,  and  sufficiently  long  to  make  a 
night's  rest  of,  say  seven  or  eight  hours  at  least,  it  is  worth  while 
to  swallow  a  full  dose  of  chloral  on  embarking,  and  to  sleep 
through  one's  troubles.  But  if  you  have  to  wake  up  in  two 
or  three  hours  to  disembark,  you  feel  ill  all  the  next  day,  if  not 
longer. 

Ice-bags,  and  all  other  charms  for  sea-sickness,  have  turned  out 
mere  trade  puffs. 


CLIMATE.  175 


CHAPTER  VIII. 

EFFECTS   OF   CLIMATE. 

THE  race  of  man  exhibits  great  powers  of  resistance  to  external 
influences,  and  is  able  to  occupy  a  length  and  breadth  of  the  earth's 
surface  such  as  is  attained  by  no  other  animal  or  even  plant. 
This  arises  not  from  any  innate  bodily  strength,  but  from  his 
being  able  to  accommodate  himself  by  the  aid  of  reason  to  circum- 
stances. Thus  experience  has  led  to  the  adoption  of  very  differ- 
ent  dietaries  in  different  regions.  An  Esquimaux  would  find 
much  difficulty  in  growing  rice  near  his  home,  so  he  wisely  dines 
on  such  meat  as  he  can  get  or  on  whale-bubbler.  A  Bengalee 
could  not  obtain  a  supply  of  flesh  food  without  immense  labor, 
and  finds  rice  grown  easily,  so  he  lives  almost  entirely  on  the 
latter.  The  curiosities  of  food  afford  examples  of  the  boldness  of 
man  in  not  being  deterred  by  their  repulsiveness  to  his  senses  from 
converting  assimilable  substances  to  his  use,  enough  to  make  the 
simple  reader  shudder ;  but  I  do  not  know  that  the  philosopher 
gains  much  knowledge  from  such  recitals.  Man  learns  to  swal- 
low, bon  gre,  mal  gre,  whatever  contains  aliment,  and  the  art  of 
living  lies  in  the  learning  so  to  eat  it  as  that  it  shall  serve  his 
turn.  Climate  influences  diet  mainly  by  the  supply  it  affords. 

In  most  warm  countries  there  is  an  abundance  of  starchy  and 
sugary  food,  and  but  little  animal.  How  shall  this  existent  pro- 
vision be  made  most  available  for  the  prolongation  of  life  ?  Let 
us  refer  back  to  the  principle  on  which  were  reckoned  in  the  first 
part  of  this  volume  the  requirements  of  the  body  for  its  daily 
work  (p.  21),  and  draw  the  obvious  inferences  therefrom.  The 
diet  is,  in  hot  countries,  perforce  one  that  entails  the  loading  the 
digestive  organs  with  a  great  excess  of  carbon  in  order  that  enough 
nitrogen  may  be  obtained.  In  the  first  place,  therefore,  the  car- 
bon should  not  be  in  too  rapidly  digestible  a  form.  Starch  and 
vegetable  fibre,  as  supplied  by  grain  and  green  food,  are  better 
than  oleaginous  matter  in  warm  climates ;  for  while  the  former 


176  SPECIAL    DIETETICS    OF    HEALTH. 

only  overloads  the  intestinal  canal,  the  latter  overloads  the  blood 
and  tissues  with  useless  and  deleterious  products.  Then,  it  is 
essential  that  no  frequent  calls  should  be  made  for  unusual  exer- 
tion :  the  muscles  and  nerves  must  not  be  worn  out,  for  the  mate- 
rials of  their  repair  are  few.  Moreover,  the  supply  of  food  must 
be  continuously  copious  and  accessible ;  for  starvation  is  badly 
borne  by  him  who  is  hanging  on  to  life  "  by  the  skin  of  his  teeth." 
No  sudden  changes  must  be  made  in  the  dietary,  even  in  the  form 
of  the  vegetable  food ;  for  a  new  article  is  with  difficulty  digested 
by  an  unhabituated  stomach,  though  it  should  be  perhaps  more 
ordinarily  digestible  than  the  usual  nutriment.  This  is  not  the 
case  with  meat-eaters,  who  can  bear  change  much  easier  from  one 
kind  of  flesh-food  to  another. 

The  English  reader's  interest  in  his  fellow-subjects  will  natu- 
rally suggest  to  him  the  important  bearing  which  these  consider- 
ations have  on  the  duties  of  both  government  and  individuals 
towards  the  inhabitants  of  our  Indian  possessions.  Our  first  busi- 
ness is  to  keep  them  alive  at  whatever  cost  to  ourselves;  and  the 
next  to  render  them  as  little  dependent  as  possible  on  the  accidents 
of  drought,  flood,  and  other  unfavorable  contingencies  of  season, 
partly  by  storing  grain,  and  (what  is  infinitely  more  important) 
water,  the  means  of  producing  grain,  from  one  season  to  another. 
Tanks,  artificial  lakes,  irrigation  works,  and  roads,  stamped  with 
the  latest  improvements  of  modern  science,  will  preserve  the 
memory  of  our  rule  when  the  bronze  statues  of  our  leaders  are  as 
unintelligible  as  the  Memnon.  Who  cares  for,  or  knows  of,  the 
martial  exploits  of  the  Pharaohs  ?  Yet  their  successful  efforts  for 
regulating  the  food  supply  of  Egypt  preserve  fresh,  forever,  our 
grateful  remembrance  of  them.  The  heaven  of  nations  is  in  the 
hearts  of  men. 

Again,  we  must  not  expect  to  get  work  ouc  of  vegetable-feeders 
in  return  for  our  bounty.  If  required  to  exert  themselves  in  any 
unusual  way,  when  food  is  deficient,  they  simply  die.  The  reason 
is  evident :  they  have  been  living  on  their  own  tissues,  and  the 
small  quantity  of  albuminous  matter  in  grain  is  a  long  time  in 
building  them,  up  again ;  so  that  for  weeks  or  even  months  their 
muscles  are  in  a  state  of  atrophy.  A  broken  watch  must  be  re- 
paired before  you  call  upon  it  to  go. 


CLIMATE.  177 

Also,  any  variations  made  in  the  nature  of  their  food  must  be 
very  gradual  and  well  considered. 

Still,  there  is  no  impossibility  in  the  gradual  introduction  of 
changes,  at  least  in  the  preparation  of  food.  Some  method  might 
be  popularized  of  augmenting  the  proportion  of  nitrogenous  matter 
in  the  dietary  by  mechanically  reducing  the  carbon,  such  as  pro- 
duces in  Italy  the  highly  nutritious  macaroni.  Starch  is  readily 
washed  out  of  the  grain,  and  is  itself  a  valuable  article  of  com- 
merce for  industrial  purposes,  as  well  as  being  capable  of  conver- 
sion into  more  digestible  substances  for  use  as  food.  Also  the 
separation  of  starch  and  the  storing  it  in  a  form  less  liable  to  de- 
composition and  the  ravages  of  insects  than  ordinary  grain,  would 
be  a  great  source  of  safety  to  a  graminivorous  people. 

I  had  a  striking  illustration  of  the  different  values  of  vegetable 
and  animal  food  a  few  years  ago  in  the  case  of  a  robust  Hindoo 
gentleman,  who  habitually  lived  on  rice  and  vetches,  which  he 
imported  himself  from  Bombay,  and  had  cooked  by  a  servant  of 
the  same  faith  as  himself,  so  that  his  meal  should  not  be  defiled 
by  the  touch  or  even  the  look  of  a  Christian.  The  said  servant 
went  holiday-making  to  Greenwich,  got  drunk  and  into  the 
lockup,  so  that  his  master  had  an  involuntary  fast  of  nearly  two 
days.  And-  then  he  was  so  weakened  that  the  labor  of  opening 
his  letters  brought  on  hiccough,  vomiting,  and  extreme  depression, 
so  that  he  could  not  take  food  when,  at  last,  he  obtained  it.  The 
mention  of  beef  tea  was  an  abomination  to  him;  he  said,,  his  an- 
cestors had  not  put  in  their  mouths  animal  food  for  6000  years, 
and  he  was  not  going  to  begin.  But  when  the  abominable  sub- 
stance was  craftily  introduced  to  the  other  extremity  of  the  diges- 
tive canal,  it  seemed  to  flow  directly  into  his  veins,  which  filled 
with  blood,  and  he  was  well.  The  absorbents  had  clearly  not 
lost  their  natural  habits  by  disuse  for  so  many  generations. 

Where  the  circumstances  of  a  country  are  such  that  plants  suit- 
able for  food  cannot  be  grown,  while  there  is  a  sufficient  supply 
of  animals  to  nourish  the  population,  the  inhabitants  are  hardy, 
enduring  extreme  cold  and  heat,  and  capable  of  violent  physical 
exertion.  But  steady  daily  labor  wears  them  out,  and  is  abhor- 
rent to  their  feelings.  We  may  instance,  as  under  several  varie- 
ties of  temperature,  the  Esquimaux, "the  Indians  and  half-breds  of 
the  Pampas,  the  Tartar  hordes,  and  the  Arabs  of  the  Nubian 

12 


178  SPECIAL    DIETETICS    OF    HEALTH. 

Desert.  These  nations  of  meat-eating  hunters  and  herdsmen  are 
mightily  strong  and  prolific,  and  have  fulfilled  to  them  the  prom- 
ise made  to  the  sons  of  the  wild  Sheik  Jonadab,  of  never  lacking 
"  a  man  to  stand  before  the  Lord  forever."  But  that  is  only  so 
long  as  they  follow  their  ancestral  traditions,  and  retain  habits 
suited  to  none  but  sparsely  inhabited  lands.  When  the  inevitable 
tide  of  civilization  overtakes  them,  and  they  become  cultivators 
and  craftsmen,  they  fall  under  the  natural  laws  of  population  and 
take  their  chances  with  the  rest  of  mankind.  Often,  indeed,  the 
day  goes  against  them  in  the  fight  of  innovation,  especially  if  it 
has  been  sudden ;  they  fade  away  childless  under  our  very  eyes, 
like  that  vast  American  tribe  of  which,  it  is  said,  the  only  rem- 
nants are  a  chief,  a  tomahawk,  and  six  gallons  of  whisky.  The 
only  possible  remedy  for  this  terrible  state  of  things  is  beef.  Our 
progress  is  progressively  poisoning  off  our  weaker  brethren  ;  we 
are  no  more  to  blame  for  it  than  we  are  for  crushing  the  harmless 
beetles  and  daisies  that  lie  in  our  path.  Still,  we  are  bound  in 
mercy  to  tide  them  over  the  struggle,  to  let  them  assimilate  gradu- 
ally with  the  more  civilized  world.  Hunters  should  have  facili- 
ties afforded  them  of  becoming  herdsmen,  and,  in  course  of  gener- 
ations, from  herdsmen,  farmers,  and  gardeners;  for  the  immediate 
transition  from  a  purely  animal  to  a  principally  vegetable  diet, 
though  borne  by  the  individual,  is  fatal  to  the  race. 

The  action  of  climate  on  diet  seems  to  be  affected  by  the  food 
produce  which  it  enables  the  soil  to  bring  forth.  The  fixed  in- 
habitants grow  accustomed  to  it,  and,  according  to  the  law  of  the 
survival  of  the  fittest  for  the  peculiar  circumstances,  are  prosper- 
ous and  prolific  as  a  race,  and  healthy  as  individuals,  while  fol- 
lowing their  ancestral  habits.  But  that  historic  fact  does  not  at 
all  show  either  that  the  diet  is  the  best  abstractedly,  still  less  that 
it  is  the  best  suited  to  foreigners.  It  seems  absurd  to  argue  that 
the  inhabitant  of  the  Polar  Circle  lives  on  fat  animal  food  because 
it  is  so  cold,  and,  at  the  same  time,  that  the  burning  plains  of  the 
Pampas  are  a  reason  for  thriving  on  flesh  and  water  only;  or  that 
the  climatic  circumstances  of  North  Norway  and  Southern  Spain 
are  the  cause  of  the  inhabitants  living  almost  entirely  on  bread. 
The  best  diet  in  the  abstract  is  a  mixed  diet,  and  mixed  in  the 
proportions  selected  by  the  experience  of  the  most  civilized  nations. 
And  it  is  also  the  best  for  the  individual  who  is  accustomed  to  it 


CLIMATE.  179 

to  adhere  to,  under  whatever  sky  he  may  be  wandering.  The 
higher  the  health  he  enjoys,  the  more  nearly  he  approaches  to  the 
true  aim  of  being  in  training,  the  better  he  is  able  to  resist  the 
adverse  circumstances  he  may  be  subjected  to.  Experience  does 
not  justify  an  agreement  with  those  dieticians  who  desire  us  to 
alter  our  commissariat  in  accordance  with  the  example  of  those 
among  whom  we  dwell  for  a  season,  or  in  obedience  to  the  ther- 
mometer, and  M.  Cyr  is  indubitably  wrong  when  he  blames  Britons 
for  "retaining  their  customary  substantial  regimen  under  other 
skies  and  in  hot  countries."1 

In  India  and  in  Africa  our  soldiers  suffer  from  fevers,  ague, 
dysentery,  and  are  liable  to  contract  cholera  and  other  epidemics. 
But  the  camps  of  our  foes  are  usually  still  more  severely  ravaged 
at  the  same  time;  and  it  is  observed  that  those  suffer  least  who 
continue  the  habits  of  sensible  men  at  home.  Inflammations  and 
degenerations  of  the  liver  also  afflict  our  countrymen  in  the  East, 
and  a  certain  proportion  of  this  evil  is  due  to  intemperance,  as  it  is 
in  England ;  but  the  great  majority  of  the  cases  are  traceable  to  the 
consequences  of  malarious  fever.  It  does  not  appear  that  those 
who  make  a  rational  use  of  alcohol,  as  they  would  have  done  at 
home,  suffer  more  than  the  abstinent.  The  principal  thing  to  be 
remembered  is  that  as  the  outgoings  of  water  by  skin  and  lungs 
are  very  great,  the  ingoings  must  be  great  also,  and  therefore  that 
the  fermented  drinks  must  be  taken  in  a  dilute  form,  otherwise, 
thirst  will  cause  an  excess  of  stimulant  to  be  consumed.  This  ap- 
plies equally  to  the  warm  summers  in  dry  temperate  climates,  such 
as  Italy,  as  well  as  to  tropical  regions. 

The  object  of  attention  to  diet  in  unaccustomed  climates  should 
be  to  accommodate  to  the  demands  of  the  system  the  food  which 
can  be  obtained,  and  to  which  we  are  obliged  by  necessity  to  re- 
strict ourselves.  If  starchy  food  is  to  be  got,  solely  or  mainly,  a 
great  deal  of  it  must  be  eaten,  and  the  digestion  of  this  unusual 
mass  is  facilitated  by  being  taken  alone  -and  not  mixed  with  meat; 
and  the  meat,  when  it  comes  to  hand,  should  form  a  separate  meal. 
Thus  the  full  force  of  salivary  digestion  is  brought  into  play.  In- 
voluntary vegetarians  are  apt  to  starve  themselves  from  want  of 
inclination  towards  the  flavorless  viands.  They  should  be  warned 

1  Traite  dc  1'Alimentation,  p.  221. 


180  SPECIAL    DIETETICS    OF    HEALTH. 

of  the  danger  of  this.  If  nothing  but  animal  food  is  within  reach, 
again,  still  more  is  it  imperative  to  eat  largely,  if  the  body  is  to 
be  preserved  in  its  integrity,  as  has  been  argued  in  a  previous 
chapter  (p.  21).  Sir  John  Koss  found  the  Esquimaux  devour- 
ing about  twenty  pounds  a  day  of  meat  and  blubber.  And  his 
experience  among  his  own  men  leads  him  to  urge  the  desirability 
of  acquiring,  previously  to  a  contemplated  winter  residence  in 
Polar  regions,  a  taste  for  Greenland  food,  the  large  consumption 
of  it  being  the  true  secret  of  life  in  those  frozen  countries.  "  The 
quantity  of  food,"  he  says,  "  should  be  increased,  be  that  as  incon- 
venient as  it  may."1  Again,  Sir  Francis  Head,  in  his  famous 
journey  across  the  burning  plains  of  the  Pampas,  where  beef  and 
water  were  the  only  victuals  to  be  had,  got  himself  into  magnifi- 
cent condition,  not  by  dint  of  the  limited  slices  of  civilized  society, 
but  by  eating  flesh,  morning,  noon,  and  night,  liberally.2  Under 
both  circumstances  the  addition  of  a  small  quantity  of  vegetable 
food  would  have  rendered  needless  the  excess  of  nitrogenous  ali- 
ment. 

When  the  Englishman  is  in  foreign  countries  it  is  more  neces- 
sary than  at  home  to  pay  that  attention  to  diet  which  will  insure 
the  highest  attainable  health  and  condition.  For  to  his  constitu- 
tion, at  any  rate,  if  not  absolutely,  every  place  is  less  healthy  than 
England.  Plagues  of  all  sorts,  terrestrial  and  celestial,  beset  his 
path,  and  he  must  walk  warily  if  he  would  return  sound.  Per- 
haps, at  home  he  may  have  lived  carelessly,  and  been  lucky 
enough  not  to  suffer,  but  he  cannot  hope  for  the  same  good  fortune 
under  less  favorable  auspices.  This  caution  is  not  required  by 
the  sensible  readers  of  these  pages,  but  it  may  be  useful  in  its  ap- 
plication to  their  less  wise  dependents  and  clients,  who,  in  coun- 
tries where  one  is  always  thirsty  and  there  is  abundance  of  drink, 
are  as  apt  to  yield  to  temptation  as  in  England.  The  punishment 
of  stupidity  is  surer  and  heavier  than  they  are  led  to  anticipate  by 
former  experience. 

Exercise  and  clothing  should  be  accommodated  to  the  food. 
We  should  not  in  these  particulars  copy  the  manners  of  natives 
any  more  than  we  do  their  dietary.  Active  muscularity  and  field 

1  Boss,  Second  Voyage  for  the  Discovery  of  the  Northwest  Passage,  p.  413. 

2  Head's  Journey  across  the  Pampas  (1828), 


CLIMATE.  181 

sports  render  the  body  less  likely  to  suffer  from  the  solar  and  ma- 
larious influences  to  which  they,  to  a  certain  extent,  expose  those 
who  pursue  them;  and  the  simple  precautions  of  keeping  the  skin 
dry  and  warm  after  exertion,  and  of  taking  small  preventive  doses 
of  quinine,  will  make  these  healthy  pleasures  nearly  as  safe  in  the 
tropics  as  in  Europe,  times  and  places  of  extraordinary  risk  being 
avoided. 

In  the  selection  of  fit  persons  to  undergo,  with  safety  to  them- 
selves and  others,  exposure  to  extremes  of  either  cold  or  heat,  the 
surest  guide  is  their  power  of  gaining  weight  and  condition  under 
a  course  of  training.  These  are  not  always  persons  of  the  biggest 
muscles  and  bones;  indeed,  a  moderately  sized  frame  is  the  tough- 
est as  a  rule.  Sheer  pluck  will  sometimes  enable  a  most  unfit 
subject  to  pass  undetected  through  tests  of  endurance;  and  doubt- 
less such  a  temper  is  valuable  in  a  colleague;  but  it  will  not  sup- 
ply the  place  of  hardihood.  The  surest  proof  of  hardihood  is  im- 
provement under  training. 

As  the  women  desiring  to  undergo  bodily  hardship  are  more 
exceptional  than  men,  so  is  it  all  the  more  necessary  to  test  them 
thoroughly.  Their  desire  is  almost  always  the  self-sacrifice  of 
love ;  but  they  do  not  wish  to  burden  others  with  bitter  memories 
or  to  injure  the  object  they  profess  to  aid,  as  happens  if  they  break 
down.  The  world  has  less  direct  claim  on  their  assistance,  and 
therefore  they  should  not  offer  it  without  being  sure  that  it  is 
really  worth  having.  This  specially  applies  to  the  wives  of  mis- 
sionaries, travellers  in  new  countries,  emissaries  to  barbarous  na- 
tions, and  the  like.  They  are  of  incalculable  service  while  sound, 
but  a  serious  impediment  when  sick.  Their  enduring  courage 
may  be  taken  for  granted,  as  it  is  proved  by  their  volunteering. 
But  unless  they  grow  in  strength  and  weight,  or  at  least  preserve 
their  weight,  under  a  course  of  training,  their  place  is  home. 

The  standard  chapter  in  dietetic  treatises  on  the  due  influence 
of  the  seasons  on  the  selection  of  food  in  temperate  climates  does 
not  exhibit  any  practical  contributions  of  science.  We  hardly  re- 
quire to  be  told  to  indulge  more  in  weak  potations  in  July  than 
in  December,  or  to  eat  a  better  dinner  when  our  appetite  is  braced 
up  by  a  frost.  Some  of  their  refinements  remind  one  of  the  dan- 
dies in  Imperial  Rome  who  wore  heavy  finger-rings  in  winter  and 
light  in  summer,  and  are  beneath  the  notice  of  a  healthy  man. 


182  SPECIAL    DIETETICS    OF    HEALTH. 

Some  are  positively  repugnant  to  experience,  as,  for  example,  the 
recommendation  to  keep  out  the  cold  by  eating  sugary  and  starchy 
dishes,  on  the  ground  that  they  are  producers  of  heat  by  combus- 
tion. The  loss  of  heat  by  evaporation  makes  it  quite  as  necessary 
to  sustain  the  temperature  of  the  body  in  summer  as  in  winter, 
and  the  same  amount  of  force  has  to  be  elicited;  so  that,  as  a  mat- 
ter of  fact,  meals  of  bread  and  pastry  and  sweet  fruits  are  more 
seasonable  in  warm  weather  than  in  cold,  for  they  cause  less  fever- 
ishuess  and  excitement  than  meat  does.  The  succession  in  their 
due  season  of  .marketable  articles  affords  a  sufficient  guide  to  their 
selection.  As  an  almost  universal  rule  they  are  wholesomest 
when  cheapest,  if  the  simple  directions  given  already  for  securing 
their  soundness  and  freedom  from  adulteration  be  adhered  to. 

Sir  James  Clark1  remarks  that  "  change  of  air  is  not  more  val- 
uable as  a  remedy  in  the  cure  of  disease  and  its  consequences,  than 
as  a  preventive  of  disease,  more  especially  in  childhood  and  youth." 
It  is  upon  the  appetite  that  its  effect  is  first  marked,  and  no  doubt 
this  is  most  prominent  when  the  change  is  from  an  impure  to  a 
purer  air.  Yet  I  have  known  the  mere  change  alone  to  have  a 
beneficial  influence,  as,  for  instance,  a  removal  for  a  time  from  the 
seaside  or  the  fresh  breezes  of  the  Worcestershire  hills  to  London. 
Observation  does  not  incline  me  to  have  faith  in  the  doctrine  of 
acclimatization.  It  seems  to  me  that  a  long  residence  in  a  climate, 
instead  of  rendering  it  more  salubrious  to  the  resider,  makes  it 
less  suitable  in  close  proportion  to  its  length.  I  cannot  at  all  join 
Claudian  in  his  praise  of  the  old  man  of  Verona,  who  attained  the 
age  of  ninety  without  ever  going  out  of  the  suburbs.2  He  used 
his  natural  toughness  to  set  a  very  bad  example  to  his  neighbors ; 
and  if  many  followed  it,  I  am  sure  some  must  have  suffered  in 
mind  and  body. 

In  choosing  a  place  of  education  for  children,  it  is  desirable  that 
the  climate  should  be  decidedly  different  from  that  enjoyed  at 
home  during  the  holidays.  Denizens  of  the  stagnating,  oft- 
breathed  atmosphere  of  a  metropolis  will  do  well  to  select  a  coun- 
try school ;  dwellers  on  the  high  ground  of  central  England  will 
find  what  suits  them  best  on  the  coast ;  while  both  the  seasiders 

1  Cyclopaedia  of  Practical  Medicine,  i,49. 

2  De  sene  Veronensi  epigramma. 


CLIMATE.  183 

and  country  folks  may  venture,  without  risk  of  deterioration,  to 
.-(•cure  for  their  growing  families  the  many  advantages  of  instruc- 
tion in  a  town. 

Clergymen  whose  health  is  below  par  and  even  verging  on  dis- 
.  will  often  gain  wonderfully  by  a  mutual  exchange  of  duty, 
provided  the  climates  of  their  several  spheres  are  different.  Satirists 
say  that  parsons'  livings  always  disagree  with  them ;  and  there  is 
a  strong  spice  of  fact  in  the  statement ;  it  is  not  fancy*,  but  a  real 
stagnation,  from  monotony  in  their  aerial  and  other  surroundings. 
The  remedy  is  easy  and  cheap,  but  the  physiological.conditions  of 
it  should  be  clearly  understood.  It  would  be  a  profitable  subject 
for  bishops  and  archdeacons  to  dilate  upon  in  their  charges,  as  it 
is  quite  as  important  to  the  public  that  clergymen  should  be  kept 
in  repair  as  that  churches  should  be  so  attended  to. 


184  SPECIAL    DIETETICS    OF    HEALTH. 


CHAPTER  IX. 

STARVATION,  POVERTY,  AND   FASTING. 

/ 

Starvation. 

THERE  has  always  been  a  certain  amount  of  importance  attached 
to  the  diet  and  regimen  of  the  sick,  but  not  till  the  present  gene- 
ration do  we  find  any  notice  taken  by  men  of  science  of  the  conse- 
quences to  the  healthy,  of  its  insufficiency  or  imperfection.  The 
remarkable  researches  of  Chossat  on  Inanition1  form  the  first  im- 
portant work  published  on  this  point.  The  results  deduced  by 
this  physiologist  from  his  experiments  have  only  been  confirmed 
and  expanded  by  later  observers. 

The  first  and  most  important  principle  established  by  Chossat  is 
that  absolute  deprivation  of  food  and  deficiency  of  food  are  phys- 
iologically identical  in  their  action  on  the  animal  life.  One  acts 
quicker  than  the  other,  but  the  diiference  is  merely  one  of  dura- 
tion and  degree.  Both  are  equally  fatal  in  the  end,  if  not  inter- 
fered with ;  and  the  end  in  both  is  regulated  by  the  same  law. 
Death  arrives  when  the  body  has  lost  T60  of  its  weight,  whether 
that  happens  after  days,  or  months,  or  years. 

The  loss  of  temperature  is  a  feature  common  to  and  identical  in 
both.  Starvation  or  abstinence  proved  almost  always  fatal,  in 
Chossat's  observations,  whenever  the  animal  warmth  fell  to  about 
76°  (Fahr.)  in  a  red-blooded  creature.  The  importance  of  the 
loss  of  temperature  was  shown  by  the  fact  that  a  renewal  of  con- 
sciousness and  nerve-power  could  be  effected,  even  from  the  torpor 
preceding  death,  by  the  application  of  external  warmth.  This 
fact  affords  a  most  valuable  hint  for  the  management  not  only  of 
absolutely  starved  but  of  poorly  fed  individuals. 

The  sensations  of  hunger  need  not  be  described.  After  a  time 
these  are  appeased,  and  are  succeeded  by  a  working  and  a  grum- 
bling and  a  dull  aching  in  the  small  intestine.  Then  the  secre- 

1  Chossat,  sur  1'Inanition,  Paris,  1843. 


STARVATION — POVERTY — FASTING.  185 

tions  of  the  abdominal  canal  diminish  and  finally  nearly  cease. 
Digestion  becomes  more  and  more  difficult,  the  longer  the  absti- 
nence. In  fact,  an  insufficient  diet  is  not  only  hurtful  imme- 
diately, but  it  brings  on  an  additional  danger  which  acts  in  the 
same  direction,  namely — an  impediment  to  absorption.  The  ap- 
petite falls  off,  and  it  is  only  from  habit  that  the  sufferer  is  induced 
to  seek  the  food  for  want  of  which  he  is  perishing. 

There  is  absolute  constipation,  as  may  be  daily  noticed  in  hys- 
terical subjects  and  others  who  do  not  take  nutriment.  And  the 
forcible  relief  of  this  constipation  by  drugs  makes  matters  worse, 
as  we  may  also  observe  in  the  same  hysterical  subjects  under 
foolish  maternal  discipline. 

The  breathing  goes  on  gradually  getting  slower  and  less  deep. 
In  a  case  of  starvation  for  twenty-four  hours,  Dr.  Smith  found 
the  exhalation  of  carbonic  acid  fall  from  34  ounces  per  diem  to  22 
(Philos.  Trans.,  1859).  Fasting  ecstatics  hardly  seem  to  breathe 
at  all ;  and  if  you  watch  at  rest  a  London  needlewoman,  or  pau- 
per before  she  goes  into  "  the  house,"  the  motion  of  the  ribs  can- 
not be  seen,  so  little  air  does  she  draw  in.  Contrasted  with  this 
is  the  gasping  rapidity  with  which  the  respiratory  muscles  act 
when  forced  exertion  sets  them  in  motion. 

The  alterations  in  the  blood  consequent  on  insufficient  food  de- 
pend on  whether  there  has  been  a  deprivation  of  water  or  not  at 
the  same  time  with  solids.  If  there  has,  strange  to  say,  the  pro- 
portions of  the  ingredients  of  the  circulating  fluid  are  not  affected, 
but  the  whole  quantity  is  diminished.  In  animals  starved  to 
death,  three-quarters  of  the  blood  was  gone.  But  where  water  is 
abundant,  and  the  starvation  gradual  and  not  immediately  fatal, 
it  is  easy  to  see  by  the  coloring  of  the  lips  that  the  change  consists 
in  the  dilution  of  the  nutrient  stream  with  aqueous  fluid.  In  a 
ghastly  picture  exhibited  at  the  last  season  of  the  Royal  Academy 
(1874),  "  The  Door  of  a  Casual  Ward,"  it  was  singular  to  notice 
how  the  secret  of  the  weird  and  true  effect  of  color  lay  in  the  omis- 
sion of  vermilion  from  the  flesh  tints.  This  abstraction  was  natu- 
ral, for  the  reason  that  it  was  an  imitation  of  the  inner  work  of 
nature,  not  of  the  mere  outside. 

The  nervous  system  shows  how  it  suffers  from  inanition  by  gid- 
diness, fainting,  hallucination,  and  delirium.  During  sleep  the 
dreams  are  most  characteristic,  presenting  wondrous  scenes  of  fes- 


186  SPECIAL    DIETETICS    OF    HEALTH. 

tivity  and  sensual  enjoyment.  Lately  Mr.  Parrot1  has  believed 
he  has  traced  to  inanition  certain  tissue  changes  in  the  nervous 
system,  as  well  as  in  the  other  viscera,  which  would  appear  to  be 
the  material  expression  of  the  functional  derangements  first 
named. 

In  an  account  by  Mr.  Brett  in  the  "  Medico-Chirurgical  Re- 
view "  (1841)  of  the  denizens  of  the  Indian  prisons  at  Moor- 
shedabad,  Cawnpore,  and  Shahjehanpore,  one  of  the  most  notable 
results  of  insufficient  food  was  a  peculiar  glassy  appearance  in  the 
eye  followed  by  inflammation  and  ulcer  of  the  cornea,  a  copious 
secretion  of  tears  and  from  the  Meibomian  glands,  and  finally 
blindness  from  destruction  of  the  eyeballs,  and  death  by  emacia- 
tion. Strange  to  say,  these  dreadful  symptoms  in  such  a  sensitive 
part  were  accompanied  by  no  pain.  The  same  phenomena  were 
observed  long  ago  by  Magendie  in  dogs  starved  to  death  by  dep- 
rivation of  all  nutriment,  and  they  occur  also  when  gelatin  only 
is  supplied. 

Among  the  poor,  especially  among  children  badly  fed,  very 
similar  affections  of  the  eyes  are  frequent.  They  rarely,  however, 
go  on  to  the  lengths  mentioned  above,  for  the  sufferers  come  under 
medical  care,  are  sent  into  hospitals  or  parish  infirmaries,  and  are 
reinstated  with  nourishing  diet.  A  recognition  of  the  true  origin 
of  many  ophthalmic  epidemics  in  reformatories,  pauper  nurseries, 
and  such-like  collections  of  infantile  weakness  is  very  necessary 
to  be  impressed  upon  the  managers  of  those  institutions.  Not 
being  medical  men,  they  are  prone  to  apply,  universally,  princi- 
ples of  regimen  suited  only  to  their  own  over-fed  nurseries,  and 
to  cure  all  inflammations  by  restriction,  till  they  discover  their 
mistake  by  sad  experience. 

If  the  lack  of  nitrogenous  food  is  too  prolonged,  since  it  is  the 
blood  which  is  subjected  to  the  greatest  drain,  and  since  in  fat 
persons  the  blood  errs  by  defect  rather  than  by  excess,  inanition 
can  exist  while  the  body  still  retains  its  fat.  In  the  case  of  the 
Welsh  fasting-girl2  the  body  was  found  after  death  plump  and 

1  Compt.  rend.,  Acad.  des  Sciences,  1868,  t.  ii,  p.  412.    Dr.  Brown-Sequard 
calls  this  Steatose  interstitielle  diffuse  de  1'encephale.     By  long-lasting  in- 
sufficiency of  food  the  brain  is  more  or  less  converted  into  a  suety  substance. 

2  This  was  a  case  of  notorious  imposition,  which  the  daily  papers  in  1869 
detailed  very  fully.     The  parents  made  a  show  of  her,  decking  her  out  like 


STARVATION — POVERTY — FASTING.  187 

with  a  considerable  quantity  of  adipose  tissue  upon  it,  though  the 
jury  was  quite  right  in  finding  that  she  was  indubitably  starved 
to  death.  This  is  a  fact  of  great  importance  in  practice :  one 
must  be  very  circumspect  in  starving  or  bleeding  a  stout  patient ; 
doubtless  the  store  of  adipose  tissue  may  serve  partly  to  nourish 
him,  but  it  will  not  keep  him  alive.  In  our  treatment  of  the 
poor  we  must  apply  the  same  reasoning,  and  not  suppose  that  be- 
cause a  client,  especially  in  old  age,  is  fat,  that  he  is  therefore  in 
good  case  and  capable  of  bearing  restricted  diet.  Jailers  have 
sometimes  attempted,  really  more  from  mistaken  kindness  than 
harshness,  to  "tone  down"  an  obese  prisoner  with- hard  fare;  and 
the  consequence  usually  is  that  the  country  is  put  to  the  expense 
of  sending  him  to  the  infirmary. 

"When  entirely  deprived  of  nutriment  we  are  capable  of  sup- 
porting life  for  little  more  than  a  week.  The  Welsh  fasting-girl 
lived  for  eight  days  from  the  commencement  of  the  time  she  was 
carefully  watched.  But  so  many  circumstances  influence  the 
amount  of  resistance  which  the  body  can  exhibit,  and  make  it 
vary  so  much,  that  no  practical  importance  attaches  to  the  theo- 
retical limit  of  possible  existence. 

One  thing  which  remarkably  prolongs  the  duration  of  life  is  a 
supply  of  water.  Dogs  furnished  with  as  much  as  they  wanted 
to  drink  were  found  by  M.  Chossat  to  live  three  times  as  long  as 
those  who  were  deprived  of  liquids  and  solids  at  the  same  time. 
Miners  who  have  got  shut  up  in  damp  headings  have  experienced 
much  relief  by  getting  moisture  from  the  walls  of  their  prison. 
Even  wetting  the  skin  with  sea-water  has  been  found  useful  by 
shipwrecked  sailors.  The  fact  is  water  is  a  food,  necessary  to  the 
building  up  of  the  body,  and  I  think  a  great  mistake  is  made 
when  we  caution  the  underfed  against  a  free  use  of  it.  And, 

a  bride  on  a  bed,  and  asserting  that  she  had  eaten  no  food  for  two  years. 
Some  reckless  enthusiasts  for  strict  truth  set  four  trustworthy  nurses  to  watch 
her  ;  the  Celtic  obstinacy  of  the  parents  was  roused,  and  in  defence  of  their 
imposture  they  allowed  death  to  take  place  in  the  usual  time  which  it  does 
after  total  deprivation  of  food.  They  were  found  guilty  of  manslaughter  with 
perfect  justice,  for  the  law  rightly  supposes  everybody  to  know  that  a  human 
being  without  food  must  necessarily  die.  There  was  no  need  to  prove  the 
fact  by  a  cruel  experiment,  and  to  visit  a  poor  crazy  swindler  with  the  pun- 
ishment of  death.  Thus  to  take  the  moral  government  of  the  universe  into 
private  hands  is  quite  unjustifiable. 


188  SPECIAL    DIETETICS    OF    HEALTH. 

moreover,  water  prevents  that  concentration  of  the  circulating 
fluid  which  impedes  absorption,  and  which  is  a  serious  hastener 
of  fatal  results  in  those  who  have  not  enough  to  eat. 

Though,  as  was  before  noticed,  a  certain  amount  of  fat  on  the 
body  does  not  prevent  the  blood  from  being  impoverished,  and  by 
its  impoverishment  leading  to  injurious  results,  yet  fat  is  a  con- 
siderable protection  against  starvation.  The  old  tale  of  the  pig 
which  was  buried  by  the  fall  of  a  cliff  at  Dover,  and  was  dug  out 
alive  after  160  days,  as  recorded  by  Mr.  Mantell,  the  naturalist, 
sixty  years  since,  in  the  "  Transactions  of  the  Linnean  Society  " 
(vol.  xi),  is  a  standing  case  to  cite.  The  loss  of  substance, 
amounting  to  three-quarters  of  the  entire  animal,  is  probably  an 
exaggeration,  as  the  weight  previous  to  the  imprisonment  is  esti- 
mated by  guess ;  but  still  the  duration  of  the  starvation,  palliated 
only  by  the  moisture  which  oozed  through  the  sides  of  the  sty,  is 
very  remarkable,  and  may  certainly  be  taken  as  evidence  of  the 
protection  afforded  by  the  adipose  tissue. 

Life  can  be  supported  by  a  very  minute  quantity  of  food  as 
long  as  complete  inactivity  of  body  is  maintained.  But  under 
such  circumstances  the  slightest  exertion  will  bring  on  a  fatal 
result.  I  attended  for  a  long  time  a  surgeon  whose  power  of 
swallowing  was  completely  lost  by  cancer  of  the  esophagus.  He 
was  cheerful  and  happy  as  long  as  he  lay  in  bed,  but  at  last  dur- 
ing my  absence  from  London,  he  thought  a  trip  to  Greenwich  in 
a  steamer  would  be  an  agreeable  change,  and  died  immediately 
after  the  exertion. 

An  even  elevated  temperature  and  the  exclusion  of  the  sun's 
rays,  as  in  the  "dim  religious  light"  of  a  closed  bed-room,  will 
enable  life  to  go  on  slowly  for  a  marvellous  period  ;  as  in  the  case 
of  ecstatics,  fasters,  hysterical  and  insane  persons.  But  if  these 
are  suddenly  routed  out,  mentally  excited,  and  forced  to  live  like 
other  people  without  due  preparation,  they  die  in  spite  of  the 
soundness  of  all  their  organs.  It  is  the  same  with  convalescents 
from  acute  fevers,  if  they  are  injudiciously  roused  to  mental  or 
bodily  activity. 

Sex  seems  to  have  no  appreciable  influence  on  resistance  to  de- 
ficient diet.  But  it  is  not  so  with  age.  It  is  an  observation  of 
the  rough  old  times  when  famine  was  oftener  seen  (and  therefore 


STARVATION — POVERTY — FASTING.  189 

\ve  may  trust  Hippocrates)1  that  the  younger  a  human  being  is, 
the  easier  is  it  starved,  till  we  come  to  extreme  old  age,  when  the 
powers  of  life  are  considered  by  some  physiologists,  Celsus  among 
the  number,  to  give  way  quicker  under  famine  than  those  of  mid- 
dle-aged men.  However,  there  is  no  difference  of  opinion  as  to 
its  effect  upon  children.  Very  large  is  the  number  of  victims  to 
this  law  of  nature,  and  Malthusian  optimists  may  admire  its 
equity  in  balancing  population  and  food.  Nevertheless,  so  long 
as  wide  tracts  of  the  earth  lie  uncultivated,  we  may  not  impru- 
dently suspend  its  operation  as  much  as  we  can.  Dispensary  and 
parochial  practitioners  are  sadly  familiar  with  a  mass  of  infantile 
sickness  and  death  which  they  classify  on  paper  to  a  certain  ex- 
tent, under  heads  prescribed  by  the  Nomenclature  of  Disease,  but 
which  appeals  to  their  hearts  by  its  real  terrible  name  "  Starva- 
tion." Europe  is  deeply  indebted  to  M.  Parrot  for  the  bold  out- 
lines with  which  (in  the  "Archives  de  Physiologic"  for  1868) 
he  sketches  the  condition  in  which  an  innumerable  army  of 
speechless  martyrs  are  found  in  the  great  centres  of  civilization. 

"  In  these  little  creatures,"  he  says,  "  we  see  the  functions 
growing  weaker  and  weaker  with  extreme  rapidity,  though  in  a 
gradual  manner.  The  temperature,  often  lower  in  the  interior  of 
the  body  than  in  the  axillae,  falls  below  92°  (Fahr.)  and  is  never 
above  95°.  (We  all  know  what  'blood-heat' is.)  Usually  not 
more  than  90  beats  in  a  minute  can  be  counted  in  the  pulse ;  once 
the  number  was  over  100,  in  another  case  it  was  below  64.  The 
respiratory  movements  were  less  frequent  than  in  the  normal  state 
and  often  very  weak.  The  cries,  which  in  some  were  at  first  in- 
tense and  prolonged,  ceased  little  by  little.  The  secretions,  always 
scanty,  ended  by  disappearing ;  more  than  once  the  napkins  put 
on  in  the  morning  were  taken  off  in  the  evening  unsoiled  and  dry. 
The  skin,  rigid,  dry  and  cold,  often  oozed  out  a  serous  fluid,  es- 
pecially in  the  dependent  parts  of  the  body.  Motionless  in  their 
cradles,  icy  cold,  with  the  face  livid  and  drawn,  as  if  they  were 
mummied,  these  still  living  babies  looked  like  corpses.  The  beating 
of  the  heart  could  not  be  heard,  and  were  it  not  for  an  occasional 


1  Aphorism  xiii.  Hippocrates  does  not  define  who  are  the  •yipsvrt:,  who  he 
says  bear  starvation  bestj  but  as  an  Ionian  he  would  probably  include  all 
over  45. 


190  SPECIAL    DIETETICS    OF    HEALTH. 

movement  of  the  breath  at  long  intervals,  it  would  have  been 
thought  that  a  body  some  time  dead  lay  under  the  eyes.  In  very 
truth,  death  had  already  taken  possession,  slowly  indeed,  and  as 
it  were  molecule  by  molecule,  but  with  a  sure  and  fatal  grasp.  .  . 
The  death  of  these  children  is  due  to  starvation ;  and  the  diseased 
appearances  revealed  by  a  post-mortem  examination,  should  be 
looked  at  not  as  the  cause  of  the  malady,  but  as  its  inevitable  con- 
sequences." 

A  common  symptom,  in  children,  of  a  diet  deficient  in  nutri- 
ment is  diarrhoaa.  It  assumes,  when  severe,  the  dysenteric  type, 
streaks  of  blood  appearing  in  the  light  green,  mucous  evacuations. 
And  so  it  gets  entered  in  the  register  as  "dysentery"  or  "inflam- 
mation of  the  bowels  "  or  "  enteritis."  But  it  does  not  appear  to 
be  contagious  or  epidemic,  like  the  dysentery  of  camps ;  and  in 
hard  times  may  be  observed  confined  to  the  children  of  a  district, 
to  the  children  in  arms,  even,  according  to  the  mode  in  which  the 
pressure  of  scarcity  falls  on  the  population. 

Yet  the  suiferers  are  probably  neither  deliberately,  nor  com- 
pletely, perhaps  not  even  knowingly,  deprived  of  nutriment. 

Evil  is  wrought 
By  want  of  thought, 
As  much  as  by  want  of  heart. 

Ask  what  they  are  fed  upon,  and  compare  it  with  what  rational 
experience  prescribes,  controlled  by  the  universally  spread  teach- 
ings of  physiology,  and  you  will  see  immediately  that  the  dietary 
errs  in  not  containing  the  essentials  of  existence.  The  food  is  not, 
strictly  speaking,  unwholesome,  but  it  errs  by  defect.  It  is  not 
food  at  all.  Reference  to  Chapters  I,  and  II,1  makes  this  clear. 
It  is  there  pointed  out  what  children  should  eat,  and  everything 
else  is  what  they  should  not. 

Not  only  youth,  but  health  and  vigor  render  the  body  less  tol- 
erant of  abstinence.  Invalids  bear  it  better  than  strong  people, 
with  a  few  special  exceptions.  Such  of  us  as  have  passed  middle 
life  cannot  but  remember,  during  the  old  reign  of  depletion  and 
restriction,  when  for  fear  of  victualling  the  disease  they  famished 
the  patient,  instances  of  the  extreme  toughness  of  the  human  race. 

1  Pp.  125  and  134. 


STARVATION — POVERTY — FASTING.  191 

Among  the  sick,  not  the  sound,  these  instances  are  recollected. 
It  is  an  act  of  mercy,  when,  in  sieges,  in  shipwrecks,  and  such- 
like disasters,  meat  and  drink  are  scarce,  to  supply  those  on  the 
invalid  list  first  and  most  bountifully — no  doubt  it  is  an  act  of 
mercy,  and  to  the  honor  of  mankind  will  probably  always  be  done 
— but  the  physiologist  must  pronounce  it  highly  imprudent  and 
far  from  being  conducive  to  final  success ;  for  the  vigorous  and 
active,  whose  blood  is  circulated  rapidly,  and  whose  muscles  are 
in  constant  movement, -really  suffer  most,  not  only  in  feeling,  but 
in  their  future  health  and  strength. 

In  order  to  preserve  life  as  long  as  possible  where  sufficient  food 
for  subsistence  cannot  be  obtained,  our  aims,  then,  should  be  to 
secure  water,  warmth,  and  complete  inaction  of  the  muscles.  The 
direst  famine  does  not  necessarily  exclude  these  preservatives,  and 
in  the  more  insidious  scarcities  whose  effects  are  noticed  chiefly 
in  children,  we  can  very  often  readily  get  as  much  of  them  as  we 
want. 

In  the  apportionment  of  a  spare  supply,  the  youngest  should 
have  the  nearest  approach  to  a  full  ration,  the  active  men  and 
women  the  next,  and  the  invalids  and  aged  the  scantiest  allow- 
ance. So  is  distributive  justice  best  satisfied. 

It  is  a  strange  thing,  and  one  which  at  first  sounds  paradoxical, 
that  the  supply  of  the  stomach  even  from  the  substance  of  the  in- 
dividual body  itself  should  tend  to  prolong  life.  A  case  of  star- 
vation for  twenty-two  days  in  an  open  boat  was  recorded  in  the 
periodical  prints  last  spring  (April  30  and  May  1,  1874)  in  which 
the  poor  victims  fought  in  their  delirium,  and  one  was  severely 
wounded.1  As  the  blood  gushed  out,  he  lapped  it  up;  and  in- 
stead of  suffering  the  fatal  weakness  which  might  have  been  ex- 
pected from  the  hemorrhage,  he  seems  to  have  done  well.  I  would 
not  build  much  on  the  rough  memories  preserved  during  such 
awful  sufferings,  were  it  not  for  the  support  afforded  by  some  ex- 
periments by  a  French  physiologist,  M.  Anselmier,  to  whom  the 
idea  occurred  of  trying  to  preserve  the  lives  of  some  dogs  by  what 
he  calls  "  artificial  autophagy."  He  fed  them  on  the  blood  taken 
from  their  own  veins  daily,  and  he  found  that  the  fatal  cooling 

1  Three  rnen  and  two  boys  were  out  for  32  days  with  only  10  days'  provis- 
ions, exclusive  of  old  boots  and  jelly-fish. 


192  SPECIAL    DIETETICS    OF    HEALTH. 

incident  to  starvation  was  thus  postponed  and  the  existence  con- 
sequently prolonged.  Life  lasted  till  the  emaciation  had  proceeded 
to  T60  of  the  weight,  instead  of  T40,  as  in  Chossat's  experiments, 
and  was  extended  to  the  fourteenth  instead  of  the  tenth  day, 
which  was  its  limit  in  those  dogs  who  were  not  bled.1 

It  is  not  likely  that  anybody  will  feel  himself  called  upon  to 
repeat  M.  Anselmier's  dreadful  experience,  but  no  one  of  us  who 
run  to  and  fro  in  the  earth  is  secure  from  the  possibility  of  ship- 
wreck, or  being  buried  alive,  say  in  a  mine  or  railway  cutting, 
and  thus  involuntarily  contributing  a  self-sacrifice  to  that  knowl- 
edge which  may  save  the  lives  of  others.  For  one  famished  crew 
that  is  picked  up,  there  are  found  dozens  of  empty  wrecks,  of 
which  it  is  never  known  how  the  once  living  freight  fared ;  and 
for  each  empty  wreck  there  are  dozens  which  have  left  no  trace. 
The  prolongation  of  life  without  provisions  is  by  no  means  a  mere 
speculative  discussion.  Were  I  in  such  a  strait  as  above  referred 
to,  my  reason  would  counsel  me,  and  I  hope  I  should  have  the 
courage  to  wound  my  veins  and  suck  the  blood. 

After  starvation,  either  complete  or  partial,  a  sudden  return  to 
full  diet  is  not  to  be  attempted.  Small  quantities  at  a  time  of  the 
most  digestible  food  must  be  given.  And  the  temperature  should 
be  artificially  sustained  till  such  time  as  the  system  is  able  to  gen- 
erate its  own  heat,  especially  in  the  interior  of  the  body.  Table- 
spoonfuls  of  hot  beef  tea  and  of  milk  constantly  administered 
("tea-cup  diet"),  form  the  most  appropriate  nutriment.  And  it 
will  be  much  assisted  by  admixture  with  a  small  quantity  of  pep- 
sin ;  but  not  too  much,  or  there  is  risk  of  diarrhrea. 

Poverty. 

The  valuable  calculations  of  Dr.  Playfair,  "  On  the  food  of  man 
in  relation  to  his  useful  work,"2  enable  us  to  arrive  at  a  very  prac- 
tical estimate  of  what  amount  of  solid  victual  is  required  by  an 

1  Archives  Gen.  de  Medecine,  I860,  vol.  i,  p.  109.     M.  Anselmier  conjec- 
tures that  the  formation  of  heat  was  due  to  the  keeping  up  of  a  certain  degree 
of  activity  in  the  gastro-intestinal   absorption,  and  the  consequent  chemical 
action  in  the  interior  of  the  body,  where  it  would  not  be  lost  by  radiation. 

2  Lecture  delivered  at  the  Royal  Institution,  London,  April  28th,  1865,  pub- 
lished by  Edmonston  and  Douglas,  Edinburgh. 


STARVATION — POVERTY— FASTING. 

adult  living  by  bodily  labor,  to  preserve  his  health  under  various 
circumstances.  The  circumstances  which  chiefly  influence  the 
required  amount  can  be  classified  as  follows : 

1.  Bare  existence; 

2.  Moderate  exercise; 

3.  Active  work; 

4.  Hard  work ; 

1.  The  diet  of  bare  existence — "subsistence  diet" — is  calcu- 
lated from  the  mean  of  sundry  prison  diets,  of  the  convalescent's 
diet  at  hospitals,  that  of  London  needlewomen,  and  of  that  sup- 
plied during  the  Lancashire  cotton-famine,  as  reported  by  Mr. 
Simon.     The  result  is  that  in  a  condition  of  low  health  without 
activity,  2|  ounces  of  nitrogenous  matter  (calculated  dry),  1  ounce 
of  fat,  12  ounces  of  starch,  and  ^  of  an  ounce  of  mineral  matters 
per  diem  are  necessary.     The  contents  in  carbon  are  7.44  ounces. 
This,  being  interpreted,  means  that  a  man  will  die  gradually  of 
starvation,  unless  his  provision  for  a  week  contains  three  pounds 
of  meat  with  a  pound  of  fat  on  it,  or  the  same  quantity  of  butter 
or  lard,  two  quartern  loaves  of  bread,  and  about  an  ounce  of  salt 
and  other  condiments.     If  he  cannot  get  the  meat,  he  must  sup- 
ply its  place  with,  at  least,  two  extra  quartern  loaves,  or  about  a 
stone  and  a  half  of  potatoes,  or  between  5  and  6  pounds  of  oat- 
meal— unless,  indeed,  he  is  so  fortunately  situated  as  to  be  able  to 
get  skimmed  milk,  of  which  five  pints  a  week  will  fairly  replace 
the  meat.     Let  it  be  understood  that  all  these  articles  must  be 
good  of  their  sort,  and  contain  no  indigestible  matter  or  adulter- 
ant.    And  there  is  no  economy  in  substituting  for  real  nutriment 
things  which  merely  stay  the  hunger  by  occupying  the  stomach 
for  a  longer  period.     The  completeness  of  the  digestion  is  thus  in- 
terfered with,  and  a  morbid  derangement  of  the  function  induced, 
which  causes  part  of  the  food  to  be  wasted. 

A  person  brought  to  bare  existence  diet  can  undergo  no  toil, 
mental  or  bodily,  under  the  penalty  of  breaking  down. 

2.  By  moderate  exercise  is  meant  the  equivalent  of  some — say 
from  5  to  7  miles — walking  daily.     Dr.  Playfair  takes  as  fairly 
representing  the  appropriate  food  of  this  class  the  dietaries  of  Eng- 
lish, French,  Prussian,  and  Austrian  soldiers  in  a  time  of  peace. 

13 


194  SPECIAL    DIETETICS    OF    HEALTH. 

The  English  soldier  on  home  service,  according  to  Dr.  Parkes,  re- 
ceives from  government  five  pounds  and  a  quarter  of  meat  and 
seven  pounds  of  bread  weekly,  and  buys  additional  bread,  vege- 
tables, milk,  and  groceries.  Now,  such  a  diet  as  this  is  amply 
sufficient  for  anybody  under  ordinary  circumstances  of  regular 
light  occupation.  But  should  extra  demands  be  made  upon  mind 
or  body,  weight  is  lost,  and,  doubtless,  if  the  demands  continue 
to  be  made,  the  health  would  seriously  suffer.  Mr.  Buckland,  of 
the  Guards,  remarks  (Soc.  of  Arts  Journal,  1863,  quoted  by  Dr. 
Playfair),  that  though  the  sergeants  fatten  upon  the  rations,  the 
quantity  is  not  sufficient  for  recruits  during  their  drills. 

3.  Active  laborers  are  reckoned  those  who  get  through  such  an 
amount  of  work  daily,  exclusive  of  Sundays,  as  may  be  repre- 
sented by  a  walk  of  twenty  miles.     Of  this  class  are  soldiers  dur- 
ing a  campaign,  letter-carriers,  engineers  employed  in  field  work 
or  as  artisans.     These  habitually  consume  on  the  average  about  a 
fifth  more  nitrogenous  food  and  twice  as  much  fat  as  the  last  class, 
while  the  quantity  of  hydrocarbons  is  not  augmented,  except  in 
the  Royal  Engineers. 

4.  Hard  work  means  that  which  is  got  through  by  English 
navvies,  hard-worked  weavers,  full-fed  tailors  and   blacksmiths. 
It  is  difficult  to  get  exact  information,  but  it  would  appear  from 
Dr.  Playfair's  estimates  that  the  addition  to  the  diet  is  entirely  in 
nitrogenous  constituents.     The  higher  their  wages  the  more  meat 
the  men  eat. 

This  neglect  of  vegetables  by  the  two  last  classes  is  in  a  physio- 
logical point  of  view  imprudent,  and  possibly  may  be  a  contribut- 
ing cause  of  that  inordinate  desire  for  alcohol  which  impoverishes 
and  degrades  them.  The  discovery  of  the  production  of  force 
from  the  assimilations  of  starch  leads  to  a  knowledge,  opposed  in- 
deed to  old  prejudices  but  supported  by  experience,  that  the  rais- 
ing of  the  energies  to  their  full  height  of  usefulness  may  be  effected 
by  vegetable  food  proportioned  to  the  increase  of  requirement,  quite 
as  well  as  by  the  more  stimulating  and  more  expensive  animal 
nutriment. 

Deficient  diet,  like  all  morbid  conditions  both  corporeal  and 
mental,  is  a  vitiating  and  degenerating  influence.  Famine  is 
naturally  the  mother  of  crimes  and  vices,  not  only  of  such  sort  as 


STARVATION — POVERTY — FASTING.  195 

will  satiate  the  gnawing  desire  for  food,  but  of  general  violence 
and  lawlessness,  ill-temper,  avarice,  lust,  and  cruelty. 

The  love  of  purposeless  destruction  exhibited  by  the  Parisian 
communists  in  our  own  day  may  be  fairly  credited  to  deficient 
food.  No  well-fed  people  could  have  wrecked  the  Vendome 
column  or  burnt  the  town-hall  and  Tuileries,  of  which  they  were 
so  proud.  They  were  like  hungry  children  smashing  their  dolls. 
And  Thucydides,  Boccaccio,  and  Defoe  are  all  agreed  as  to  the 
hideous  wickedness  exhibited  at  Athens,  Florence,  and  London, 
during  their  famine-fevers.  The  exceptional  instances  are  those 
where  individuals  or  nations  have  conquered  by  courage  and  self- 
restraint  their  natural  selfishness,  and  have  made  the  interests  of 
others  paramount  to  their  own.  Am  I  blinded  by  love  of  my 
country,  or  may  I  justly  quote  the  history  of  the  Lancashire  cot- 
ton-famine as  a  case  in  point? 

In  all  physiology  there  is  no  more  convincing  proof  of  the  be- 
nevolent government  of  the  universe  and  of  its  perfecting  influ- 
ence upon  our  race,  than  the  fact  that  directly  a  man  begins  to 
care  for  others  in  preference  to  himself  alone,  his  care  ceases  to 
wear  and  exhaust  him.  It  rather  seems  to  be  a  sustaining  force. 
Observe  a  lunatic,  induced  to  work  hard  for  some  worthy  object, 
he  grows  fat ;  let  him  sit  still  and  brood  over  his  wrongs,  and  he 
dies  emaciated.  Let  a  hypochondriac's  wife  or  child  fall  ill,  he 
is  cheerful  and  well  directly;  but  he  relapses  as  they  become  con- 
valescent, and  grows  as  thin  and  miserable  as  ever  when  he  turns 
his  attention  to  his  own  health.  This  is  the  reason  why  in  sieges 
and  famine  medical  men  have  often  remained  sleek  and  plump, 
while  their  neighbors  pined,  and  perhaps  also  why  military  offi- 
cers bear  short  rations  better  than  the  men.  Like  all  divine 
truths,  "  to  love  your  neighbor  as  yourself"  is  found  to  be  taught 
by  material  nature  as  well  as  by  revelation.1 

Fasting. 

Fasting  is  the  voluntary  restriction  of  the  diet  for  the  express 
purpose  of  developing  the  higher  features  of  the  mind.  It  is  "  a 

1  Professor  Maurice  well  remarks  in  the  preface  to  his  Moral  Philosophy 
that  the  difference  between  revelation  and  discovery  is  shown  by  the  words 
themselves  to  be  very  slight;  one  is  removing  a  veil,  the  other  is  removing  a 
cover. 


196  SPECIAL    DIETETICS    OP    HEALTH. 

means  of  grace,"  and  approved  as  such  by  religious  men  of  most 
opposite  creeds  and  diverse  nationalities.  I  am  not  going  to  ques- 
tion their  experience,  and  I  should  bow  to  it  even  if  it  differed 
from  my  own,  which  is  not  the  case.  Like  all  the  material  ma- 
chinery by  which  the  bodily  man  influences  the  spiritual  man, 
this  "  means  to  an  end  "  not  only  admits  of,  but  requires  frequently 
to  be  brought  into  harmony  with,  the  progress  of  knowledge  con- 
cerning physical  life.  And  therefore  I  think  that  in  a  manual  of 
this  sort  mention  of  it  should  not  be  omitted. 

In  the  first  place,  to  be  useful,  fasting  must  be  wholly  voluntary. 
If  forcibly  imposed  even  by  imperious  custom  or  enjoined  as  an 
end  in  itself,  its  principal  effect  is  to  sour  the  temper  and  narrow 
the  intellectual  apprehension  for  the  time  being.  In  fact  its 
physiological  action  is  a  minor  degree  of  starvation. 

To  secure  its  being  wholly  voluntary,  it  should  be  private,  as 
advised  by  the  highest  authority  of  all. 

At  the  same  time  that  the  act  is  voluntary,  the  manner  of  it  is 
best  prescribed  by  another.  If  the  peculiar  form  and  degree  of 
abstinence  are  self-imposed,  they  are  apt  to  be  excessive,  and  to  do 
harm  without  any  corresponding  advantage. 

One  of  the  highest  mental  developments  to  be  expected  from 
fasting  is  the  power  of  self-control  by  voluntary  effort.  If  a  man 
finds  himself  during  a  fast  weakened  in  his  ability  to  concentrate 
his  thoughts  and  to  keep  up  his  attention,  it  is  doing  him  no  good. 
If  the  instinctive  appetites,  implanted  by  nature,  fail  after  it,  in- 
jury to  the  health  and  individual  degeneration  follow.  For  these 
reasons  it  is  best  that  the  matter  on  which  abstinence  is  exercised 
should  be  rather  a  luxury  than  a  necessary.  It  is  quite  safe  for 
a  healthy  man  to  leave  off  tobacco,  wine,  or  beer,  spices  and 
sauces,  hot  meat,  or  even  meat  altogether,  or  vegetables  altogether 
(if  vegetables  are  a  luxury  to  him),  or  pastry,  or  sugar,  or  butter 
for  a  day  or  two  at  a  time ;  especially  if  he  withdraws  himself 
from  the  bustle  of  the  daily  occupations.  But  it  is  not  wise  to  do 
this  too  frequently,  or  to  let  the  low  diet  become  habitual.  Like  all 
acts  of  free  will,  it  is  most  powerful  in  its  effects  on  the  mind  when 
rare,  and  when  it  presents  the  strongest  contrast  to  the  usual  life. 
If  once  they  become  habits,  the  spiritual  influence  of  acts  ceases. 

Those  who  never  feast  will  find  a  difficulty  in  advantageously 
fasting. 


DECLINE    OF    LIFE.  197 


CHAPTER  X. 

THE    DECLINE   OP   LIFE. 

EVERYBODY  who  has  passed  the  age  of  fifty  (or  thereabouts) 
with  a  fairly  unimpaired  constitution  will  act  wisely  in  diminish- 
ing his  daily  allowance  of  solid  food.  At  the  "  grand  climacteric  " 
(as  this  turn  of  life  is  pompously  called)  the  movements  of  nutri- 
tion are  retarded,  and  the  constructive  and  evacuating  actions  of 
the  system  being  diminished,  there  is  less  call  for  materials  of  re- 
pair. It  becomes  a  moral  duty  to  avoid  all  articles  of  diet  which 
personal  experience  has  shown  to  be  difficult  of  solution,  to  make 
smaller  meals,  and,  if  need  be,  more  frequent  meals,  so  that  the 
stomach  may  be  never  overloaded  or  too  long  idle.  The  saving 
up  an  appetite  for  the  enjoyment  of  an  abundant  repast  may  be 
conceded  as  a  harmless  folly  in  our  juniors,  but  it  is  a  shame  to  a 
gray  head.  If  custom  has  made  a  man  a  large  eater,  he  should 
endeavor  to  "  spoil  his  dinner"  by  a  late  luncheon,  and  to  prevent, 
his  appetite  being  too  keen  at  midday  by  breakfasting  not  over 
early. 

Very  aged  people,  however,  and  those  who  have  lost  their  teeth 
run  some  risk  of  not  being  sufficiently  nourished,  from  swallow- 
ing their  food  rapidly.  They  are  hurried  over  their  meals  through 
the  thoughtlessness  of  those  around  them,  and  since  they  chew 
slowly  and  secrete  saliva  slowly,  the  food  remains  undigested. 
Their  juniors  should  remember  this,  and  govern  themselves  ac- 
cordingly. A  kindly  British  matron,  who  spent  more  hours  at 
table  than  was  good  for  her,  told  me  that  if  she  did  not  do  so,  she 
"  should  be  a  widow  in  a  week,"  and  that  she  habitually  ate  too 
much  to  keep  her  aged  husband  in  countenance.  Not  a  word 
could  be  said  against  such  pious  gluttony. 

The  dishes  of  meat  should  be  as  soft  and  tender  as  possible,  and 
the  firmer  kinds  should  be  finely  cut  with  a  mincing  knife.  But 
vegetables  should  not  be  over-softened  in  cooking :  there  should 
be  sufficient  resistance  in  them  to  make  chewing  imperative,  so  as 
to  excite  the  secretion  of  the  fluids  of  the  mouth,  which  are  re- 


198  SPECIAL    DIETETICS    OF    HEALTH. 

quired  for  their  solution.  Soups  and  broths  are  nutritious,  but 
should  not  contain  solid  vegetables,  except  just  enough  to  flavor 
them.  Puddings  and  pastry  are  not  of  much  use,  and  overload 
the  tired  stomach. 

I  do  not  know  the  authority  for  the  old  proverb  vinum  lac 
senum,  but  it  seems  a  very  dangerous  one,  as  it  may  lead  our 
ancient  friends  to  think  they  may  treat  it  like  mother's  milk,  and 
measure  its  benefits  by  the  quantity  imbibed.  The  saying,  how- 
ever does  partially  embody  a  truth,  namely — that  in  the  decline 
of  life  the  advantages  derived  from  fermented  liquors  are  more 
advantageous,  and  the  injuries  it  inflicts  less  injurious  than  in 
youth.  The  eifect  of  alcohol  is  to  check  the  activity  of  destructive 
assimilation,  the  rapidity  of  that  moulting  of  the  body's  substance 
by  normal  secretion  which  in  healthy  youth  cannot  be  excessive, 
but  which  in  old  age  exhausts  the  frame.  Alcohol  calmly  arrests 
the  energies  of  the  nervous  system  which  would  fret  the  tissues  to 
decay,  and  would  seriously  weaken  them,  were  not  the  wear  and 
tear  to  be  continuously  replaced  by  new  material.  Now,  with 
years,  the  replacement  by  nutrition  is  much  diminished,  and  we, 
nevertheless,  are  apt  to  persist  in  using  our  brains  as  before.  We 
shrink,  rightly  enough,  from  being  shelved  just  when  the  rewards 
of  our  exertions  are  becoming  due ;  and  we  do  not  care  to  rival 
the  centuries  of  the  olive  or  the  yew,  unless  we  can,  like  them, 
"renew  our  age"  and  bear  fruit  unto  the  end.  Here,  then,  alco- 
hol steps  in  as  a  help  in  need,  and  it  is  strictly  in  accordance  with 
the  teachings  of  physiology  to  increase,  as  years  increase  upon  us, 
the  moderate  quantity  we  had  been  taking  previously.  I  do  not 
write  for  habitual  revellers  and  muzzy  dram-drinkers  (the  sooner 
they  become  teetotallers  the  longer  they  will  live),  but  for  the 
temperate  users  of  natural  good  things,  and  I  am  sure  that  they 
may  reasonably  obey  the  instinctive  desire  to  take  more  and 
stronger  wine  as  they  grow  in  years. 

The  physiologist  Moleschott,  moreover,  states  that  "  a  glass  or 
two  of  good  old  wine  augments  the  amount  of  gastric  juice,  the 
liquid  which  performs  mainly  the  digestion  of  albuminous  ali- 
ments."1 So  that  here  we  find  another  reason  for  indulging  the 
instinct. 

1  Kreislauf  des  Lebens,  letter  6. 


DECLINE    OF    LIFE.  199 

Elderly  people  are  able  to  do  with  less  sleep  than  younkers, 
and  need  not  be  alarmed  at  a  certain  shortening  of  their  night's 
rest,  which  is  natural.  But  sometimes  the  shortening  goes  too  far, 
even  in  health ;  they  cannot  get  to  sleep  for  a  long  time  after 
going  to  bed,  and  are  worn  out  with  restlessness  and  rolling  about ; 
not  to  mention  that  they  disturb  others  also  in  many  instances. 
This  inconvenience  may  often  be  obviated  by  having  an  egg,  a 
sandwich,  a  few  biscuits  or  other  light  repast  the  last  thing,  ac- 
companied by  a  glass  of  bitter  ale,  or  sound  wine  and  water. 
Sweet,  strong  wines  are  those  usually  recommended  for  this  pur- 
pose :  Hufeland  recommends  Malaga ;  and  Burgundy  or  Port, 
warmed,  spiced,  diluted,  and  sweetened,  is  not  a  bad  drink ;  but 
probably  the  best  for  each  individual  is  that  which  association  or 
whim  makes  most  agreeable  to  the  palate.  Some  prefer  gruel  or 
arrowroot  to  be  the  vehicle  of  the  alcohol,  and  it  certainly  dilates 
and  distributes  the  virtues  of  the  draught  efficaciously,  and  also 
warms  up  the  stomach  comfortably ;  but  it  has  a  coddling  invalid- 
ish  look  which  should  be  avoided. 

Dr.  \Velsted  considers  that  it  contributes  to  length  of  days  to 
associate  as  much  as  possible  with  young  people,  and  to  adopt 
such  habits  and  manners  as  may  attract  rather  than  repel  them, 
to  which  last  there  is  a  temptation  in  old  age.  And,  of  the  young 
people,  he  holds,  that  the  best  companions  are  those  whose  spirits 
are  high  and  joyous,  and  whom  we  can  induce  to  rally  round  and 
infect  us  with  their  life.  "  For,"  as  he  says,  "  that  solitude  which 
is  associated  with  fear  and  sorrow  breaks  up  the  strength  of  both 
mind  and  body." 

It  is  almost  needless  to  say  that  ease  of  mind,  contentment  with 
the  present,  and  calm  confidence  in  a  future  happy  renewal  of  the 
worn-out  body  and  soul,  are  specifics  suitable  for  all  cases.  .  It  is 
not  hard  work  that  kills  the  active,  nor  idleness  that  kills  the 
man  of  leisure,  be  he  old  or  young,  but  worry.  "  Be  careful  for 
nothing,  the  Lord  is  at  hand,"  is  a  motto  which  will  prolong  the 
lives  of  all. 


200 


SPECIAL    DIETETICS    OF    HEALTH. 


CHAPTER  XI. 


ALCOHOL. 

§  1.  PHYSICAL  EFFECTS. 

MANY  a  man  has  asked  himself,  like  Horace,  "  Quo  me,  Bacche, 
rapis  Tui  plenum  ?"  To  what  does  the  natural  thirst  for  alcohol 
lead  ?  He  sees  around  him  disease,  death,  and  misery  directly 
traceable  to  the  abuse;  but  he  sees  also  disease, death,  and  misery, 
arising  from  the  abuse  of  other  instinctive  desires  which  it  were 
profane  to  call  evil.  Is  there  a  use?  What  happens  to  a  tem- 
perate consumer,  likely  to  shorten  or  prolong  his  days  ?  •  Or  does 
he  merely  gain  a  pleasure  without  any  consequent  good  or  evil  ? 

It  was  with  a  view  of  getting  a  basis  for  the  satisfaction  of  my 
mind  on  these  points  that  about  fifteen  years  ago  I  engaged  a 
laboratory  assistant,  and  carried  on  the  following  experiments : 

Experiment  I. — A.  M.  aged  38,  weight  254  Ibs. — taken  at  noon  every 
day — Habits  of  life  extremely  regular.  He  walks  half  an  hour  be- 
fore breakfast  daily,  breakfasts  at  eight  on  two  cups  of  coffee,  bread 
and  butter,  and  a  slice  of  cold  meat :  dines  at  one  on  beef  and  mutton 
in  regular  quantity,  potatoes  and  pudding ;  has  tea  at  five,  two  cups 
with  bread  and  butter ;  sups  at  nine  on  bread  and  butter,  or  cheese, 
with  half  a  pint  of  ale.  He  sleeps  six  and  a  half  to  seven  hours. 
His  bowels  are  open  once  daily.  An  idea  of  the  normal  amount  of 
metamorphosis  in  his  body  is  afforded  by  the  following  table : 


a  , 

0 

_o 

a  . 

'•3  O'S 

5^5 

=  3  ~" 

Specific 
gravity. 

Urea  in 
grammes. 

Chloride  of 
sodium  in 
grammes. 

Sulphuri 
acid  in 
gramme 

Phosphor 
acid  in 
gramme 

Uric  acid 
gramme 

Amount  of  urine  and 

its      several     parts 

made  in  23  days,  in 

perfect   health    and 

on  usual  diet,  .... 

24.970 

1.022 

728.437 

174.625 

51.307 

44.719 

2.813 

Mean  daily  amount,  . 

1.085 

1022 

31.671 

7.592 

2.230 

1.944 

.187 

On  eig'ht  days  the  uric  acid  was  not  weighed. 


ALCOHOL. 


201 


The  effect  of  the  addition  of  a  certain  quantity  of  alcohol  to  the 
daily  meal  is  shown  by  the  next  table : 


Date. 

5  ' 

"*  s  « 

>.  r  ~~ 
~  ."-  ? 

<5U~ 

Specific 
gravity. 

Urea  in 

grammes. 

Chloride  of 
sodium  in 
grammes. 

Sulphuric 
acid  in 
grammes. 

Phosphoric 
acid  in 
granini''.-. 

Uric  acid  in 
grammes. 

Daily  quantity  of 
best  French 
brandy,  added  to 
mt;;ils  in  ozs.  by 
measure. 

Sep.  13, 

1,020 

1.024 

30  708 

7.140 

2017 

1.469 

4* 

"     14, 

1.570 

1.022 

39.746 

10.990 

2.579 

.848 

3 

"     19, 

1,050 

1.026 

38.795 

8.400 

2.456 

1.890 

.  .  . 

f  6,  viz.,  \\  at 

«     20, 
"     21, 

1,200 
1,110 

1.025 
1.023 

42.695 
37.974 

9.600 
6.937 

2.622 
2.212 

1.944 
1.798 

breakfast, 
1    dinner,  tea, 

"     22, 

770 

1.020 

30.030 

6.160 

2.065 

1.386 

[   and  supper. 

On  September  23,  the  appetite  for  food  was  observed  to  be  some- 
what less  than  usual,  and  the  experiment  accordingly  ceased ;  for  any 
change  of  usual  weight,  health,  feeling,  or  habits,  of  course  would 
vitiate  the  result  of  an  investigation  conducted  in  this  form. 

Here  are  shown  the  effects  of  mixing  with  the  daily  meals  such 
an  extra  quantity  of  alcoholic  liquid  as  is  very  usual  with  mod- 
erate consumers.  Such  a  quantity  seems  to  put  them  at  ease  with 
themselves  and  with  the  world  around,  without  causing  any  im- 
mediate injury  to  the  general  health,  any  untoward  exhilaration, 
or  any  subsequent  depression. 

We  may  observe : 

1.  The  aqueous  part  of  the  urine  daily  excreted  is  not  increased 
beyond,  the  extent  of  the  extra  fluid  injected. 

2.  TJie  quantity  of  urea  is  increased  after  the  first  twenty-four 
hours. 

3.  The  chloride  of  sodium  and  the  sulphates  are  slightly  increased. 

4.  The  phosphates  are  diminished. 

5.  The  augmentation  is  temporary,  and  after  a  time  is  succeeded 
by  a  reduction  to  the  normal  measure,  which  reduction  is  coincident 
with  a  loss  of  appetite. 

Alcohol,  then,  is  not  a  diuretic  in  the  commonly  received  ac- 
ceptation of  the  term,  and  the  repute  which  it  has  got  of  belong- 
ing to  that  class  of  medicines,  must  be  due  to  some  other  ingredient 
of  the  compound  forms  in  which  it  is  usually  swallowed,  or  to  its 


202  SPECIAL    DIETETICS    OF    HEALTH. 

relieving  (in  certain  cases  of  diminished  excretion)  impediments 
to  the  due  action  of  the  kidneys. 

At  the  same  time  there  is  represented  by  the  increased  forma- 
tion of  urea,  a  more  active  destructive  assimilation,  and  (inas- 
much as  the  weight  of  the  whole  body  is  not  lost)  a  more  active 
reconstruction  of  the  nitrogenous  elements  of  the  tissues.  Old 
flesh  is  removed,  and  meat  food  is  appropriated  as  new  flesh, 
somewhat  quicker  than  when  no  alcohol  is  taken. 

It  is  a  matter  of  common  observation  that  the  appetite  of  an 
average  healthy  man  has  a  keener  edge  put  to  it  by  a  moderate 
quantity  of  beer  or  wine  with  meals.  So  that  the  abovementioned 
enhancement  of  the  interstitial  growth  may  be  fairly  credited  to 
a  temporary  rise  of  the  digestive  powers  of  the  stomach. 

The  decrease  in  the  excretion  of  phosphorus  is  small  indeed  but 
indubitable.  The  chief  source  of  that  ingredient  of  the  urine 
may  be  reasonably  supposed  to  be  the  substance  of  the  brain  and 
nerves,  and  it  can  hardly  be  thought  a  mere  coincidence  when  a 
reagent  whose  effects  are  most  peculiarly  manifest  on  the  func- 
tions of  those  organs,  diminishes  what  we  believe  to  be  the  result 
of  their  chemical  changes.  Every  one  recognizes  in  alcohol  a 
power  of  blunting  sorrow  and  pain,  of  checking  the  sensation  of 
weariness,  mental  or  bodily,  of  rendering  carnal  love  coarser,  less 
keen,  and  less  discriminating,  taking  the  points  off  the  stings  and 
buffets,  discomforts  and  nastiness  of  daily  life,  but  also  of  cor- 
rupting the  delicate  appreciation  of  its  higher  delights,  in  short, 
of  diminishing  the  sensibility  to  impressions  in  mind  and  body, 
of  lowering  the  receptive  functions  of  the  nervous  system. 

In  a  series  of  experiments  conducted  for  another  object,  Dr. 
Edward  Smith  has  recorded  minutely  the  sensations  experienced 
by  a  healthy  man  on  taking  moderate  quantities  of  brandy.1 
They  consist  essentially  of  lessened  consciousness,  lessened  sensi- 
bility to  light,  to  sound,  to  touch.  The  higher  the  sensibility  of 
the  part  under  ordinary  circumstances,  the  more  obvious  its  anaes- 
thesia under  the  influence  of  brandy.  For  instance,  there  was  in 
the  upper  lip  and  cheeks  a  feeling  of  stiffness  and  puffishness, 
which  is  one  of  the  first  symptoms  of  lowered  sensation,  and  is 
familiar  to  all  in  cases  of  partial  paralysis.  The  dartos  also  and 

1  Transactions  of  Royal  Society,  1859,  p.  732. 


ALCOHOL.  203 

other  muscles  connected  with  the  reproductive  system  were  re- 
laxed ;  as  was  also  the  sphincter  of  the  bladder,  accounting  for 
the  increased  micturition  during  indulgence.  The  pulse  also  was 
quickened,  a  phenomenon  which  always  attends  temporary  de- 
bility of  the  heart's  action.  Indeed,  in  all  motion  of  a  purely 
involuntary  character,  quickness  always  indicates  diminished 
muscular  force.  (The  same  result  follows  tobacco  smoking.)  The 
sensation  of  swelling  in  the  upper  lip  is  the  premonitory  stage  of 
the  muddy  flush  by  which  the  artist  and  the  actor  mark  the  face 
of  the  "  fuddled  "  man  (ebriolus).  When  he  is  completely  intoxi- 
cated (cbrius),  it  is  oftener  pale  or  livid.  The  venous  congestion 
and  arrested  circulation  is  then  transferred  to  the  capillaries  of  the 
cerebellum  (Flourens),1  and  stomach  (Brodie),2  and  a  secondary 
series  of  phenomena  follow,  dependent  upon  the  local  affection  of 
these  organs.  There  is  a  staggering  gait,  a  want  of  co-ordination 
in  the  movements,  and  often  vomiting. 

Life  and  warmth  are  so  closely  connected  together  in  scientific 
as  well  as  in  popular  notions,  that  perhaps  the  most  striking  evi- 
dence of  diminished  vitality  is  the  lessened  capability  to  generate 
heat.  And  we  have  this  evidence  in  the  case  of  alcohol.  MM. 
Dumeril  and  Demarquay  published  in  1848  their  observation, 
that  intoxicated  dogs  exhibited  a  great  loss  of  temperature ;  and 
Dr.  Boecker3  and  Dr.  Hammond  find  in  their  own  persons  the 
same  result  from  even  moderate  doses  of  spirits.  This  accords 
with  and  explains  the  experience  of  Dr.  Rae,  that  alcoholic  drinks 
give  no  satisfaction  to  Arctic  voyagers,  and  of  Dr.  Hayes  (Surgeon 
and  Commander  in  U.  S.  second  Grinnell  Expedition),  that  they 
actually  lessen  the  power  of  resisting  cold.4  The  "  warming  of 
the  stomach  "  which  dram-drinkers  speak  of  with  such  gusto  is, 
in  fact,  a  fallacious  sensation  arising  out  of  insensibility  to  exter- 
nal influences. 

When  the  poisoning  is  still  more  profound,  the  congestion  of  the 
nervous  centres  produces  complete  apoplexy,  and  that  of  the  stom- 
ach, gastritis.  The  traces  of  these  morbid  conditions  are  found 

1  Recherchcs  sur  les  fonctions  du  systeme  nerveux,  Paris,  1824. 

2  Philosophical  Transactions,  1811. 

3  Beitrage  zur  Heilktinde,  i,  250. 

4  American  Journal  of  the  Medical  Sciences,  1859,  p.  117. 


204  SPECIAL    DIETETICS    OF    HEALTH. 

after  death,  but  the  loss  of  life  seems  due  to  the  paralysis  of  the 
respiratory  muscles  and  the  lowered  temperature  of  the  body.  I 
am  unwilling  to  enlarge  further  upon  dead  drunkenness  and  fatal 
alcoholic  poisoning,  as  I  have  no  personal  observations  on  the 
subject  to  record,  and  their  commonly  reported  characteristics  are 
repeated  here  principally  to  show  their  essential  agreement  in 
physiological  nature  with  the  healthful  and  beneficial,  or,  at  all 
events,  not  pernicious  action  of  the  substance.  The  effects  in  a 
healthy  man  would  seem  to  be  the  diminution  of  the  energizing 
wear  of  the  nervous  system,  especially  that  employed  in  emotion 
and  sensation.  Thence  there  ensues  a  raising  of  the  digestive 
powers  and  appetite,  should  they  have  been  anywise  unconsciously 
blunted  by  the  psychical  movements  abovementioned.  Just  as 
often,  then,  as  the  zest  for  food  is  so  far  lowered,  that  it  is  found 
to  be  raised  to  the  normal  standard  by  a  little  wine  or  beer  with 
a  meal,  the  moderate  drinker  is  as  much  really  better,  as  he  feels 
the  better,  for  his  liquor.  In  cases,  however,  where  the  food  is  as 
keenly  enjoyed  without  the  aid  of  any  of  the  products  of  fermen- 
tation, their  consumption  is  certainly  useless,  and  possibly  inju- 
rious. So  long  as  alcohol,  in  the  indirect  mode  mentioned,  aug- 
ments vital  metamorphosis,  it  ministers  to  the  force  of  the  body. 
But  it  is  not  a.  sojirce_of__force,  and  its  direct  action  is  an  arrest  of 
vitality.  This  should  be  clearly  understood  by  all  those  who  try 
to  have  rational  rules  to  guide  them  in  proffering  advice  as  to  the 
dietetic  use  of  a  "  stimulant."  That  word  means  a  "spur,"  and 
inasmuch  as  a  spur  is  employed  either  before  or  during  the  exer- 
tion it  is  supposed  to  bear  upon,  liquor  is  often  resorted  to  as  a 
means  of  invigorating  a  temporary  effort.  If  it  has  any  effect  at 
all  on  a  healthy  man,  it  can  but  weaken  nerve  power,  while  at  the 
same  time  it  lowers  the  bodily  temperature  which  contributes 
much  to  the  capacity  for  muscular  exertion.  Instinct  or  experi- 
ence has  taught  this  to  men  whom  we  are  pleased  to  call  barbar- 
ous. The  Indian  porters  in  South  America  (it  is  stated  by  Mr. 
Salvin,  the  ornithologist),  when  they  prepare  for  a  stiff  journey 
under  one  of  their  heavy  loads,  carefully  eschew  all  strong  drink, 
and  swallow  large  quantities  of  water  as  hot  as  the  stomach  will 
bear.  And  Aristotle  states  that  the  Carthaginians  (the  only 
African  race  ever  fit  to  fight  with  Europeans)  used  when  out  on 


ALCOHOL.  205 

military  service  to  abstain  from  wine.1  The  unhappy  adoption  of 
the  word  "stimulant"  has  demoralized  the  notions  of  civilized 
communities  on  this  head,  and  led  them  to  reckon  on  priming 
themselves  up  to  unwonted  strength  with  anesthetics.  Let  them 
rather  say  with  Byron's  Sardanapalus,  "  The  goblet  I  reserve  for 
hours  of  love,  But  war  on  water/'  and  victory  will  be  much 
surer.  There  is,  however,  another  aspect  to  the  question.  Man 
must  be  viewed  not  only  as  a  possible  victor,  but  as  liable  to  the 
reverse  fortune,  on  the  battle-field  or  in  the  struggles  of  life. 
Both  side's  cannot  win.  During  the  Crimean  war  the  Russian 
surgeons  were  reviled  for  serving  out  spirits  to  their  troops  under 
fire  ;  but  were  they  not  wise  to  calculate  the  after  consequences  of 
an  engagement,  and  to  prepare  the  bodies  of  their  clients  for  suc- 
cessfully bearing  blows  and  wounds?  "They  have  stricken  me 
and  I  knew  it  not,"  says  Solomon's  drunkard  ;  and  our  accident 
ward  at  Christmas  time  will  seldom  fail  to  show  proof  of  the 
power  to  resist  severe  injuries  conferred  by  unwonted  indulgence 
in  the  joys  of  Bacchus.  A  healthy  man  who  gets  the  worst  of  it 
in  any  way,  whose  intellectual  or  muscular  energy  goes  down 
under  the  pressure  of  the  work  demanded,  gets  the  worst  of  it  in 
a  less  degree  by  the  aid  of  strong  drink.  Give  it  him  when  ready 
to  perish  from  the  drain  on  his  nerve  tissues,  and  his  life  is  saved. 
The  laborer  whose  limbs  are  stiff  with  his  day's  toil,  and  the 
brain-worker  who  still  more  acutely  feels  the  wear  and  tear  of 
bread  winning,  are  not  wasting  the  money  they  earn,  which  they 
spend  on  a  fair  ration  of  beer  or  wine  at  their  evening  meal. 
But  if  they  take  spirits  of  a  morning  (it  is  usually  spirits  which 
are  then  taken),  never  let  them  hope  for  the  success  in  the  under- 
takings for  which  they  seemed  designed.  Both  body  and  mind 
will  be  incapacitated,  the  life  shortened,  and  all  the  keenest  joys 
taken  out  of  what  remains.  One  of  the  most  telling  questions 
that  can  be  asked  of  a  life  proposed  for  insurance  is,  "  Do  you 
ever  take  spirituous  liquors  in  the  forenoon  ?"  If  the  answer  is  in 

1  Aristoth',  (Eeonom.,  i,  5.  I  have  not  seen  this  statement  alluded  to  by 
historians,  though  it  seems  to  account  for  the  enormous  quantity  of  vinegar 
which  Livy  found  no  difficulty  in  believing  Hannibal  had  in  his  commissariat 
and  used  for  decomposing  Alpine  rocks  (Liv.  xxi,  37).  It  was  made  tasty 
with  pears  (Pallad.  in  Februar.,  xxv,  11),  and  employed  to  flavor  the  soldiers' 
drinking-water. 


206 


SPECIAL    DIETETICS    OF    HEALTH. 


the  affirmative,  an  immediate  rejection  is  the  only  safe  course  for 
the  office.  As  to  small  quantities  of  beer  or  wine  that  are  con- 
sumed between  breakfast  and  the  midday  meal,  the  evidence 
against  it  is  not  quite  so  decisive,  but,  at  all  events,  it  renders  a 
man  less  fit  for  his  daily  work  than  he  would  otherwise  be,  and  is 
a  dangerous  downward  movement  towards  the  abyss  of  dram- 
drinking.  It  will  generally  be  found  to  have  been  the  first  fatal 
step  in  the"  cases  of  women  of  the  upper  classes  who  have  adopted 
the  practice.  And,  to  the  shame  of  our  profession,  it  must  be 
confessed  that  many  of  us  have  erred  most  unhappily  by  recom- 
mending or  sanctioning  the  habit  in  weakly  or  self-indulgent 
women.  The  weaker  they  are  in  body  or  mind,  the  more  helpless 
they  are,  and  the  more  hysterical,  the  more  reason  there  is  for 
withholding  the  temptation.  We  must  be  proof  against  tears  and 
sighs,  blandishments,  entreaties,  and  reproaches,  or  we  are  not  fit 
to  bear  the  rod  of  ^Esculapius. 

See  what  happens  if,  instead  of  being  drunk  with  the  meals, 

alcohol  is  taken  in  small  divided  doses : 

\ 

Experiment  II. — The  same  man  described  in  Experiment  I,  at 
another  time  consumed  daily,  between  9  A.M.  and  9  P.M.,  six  ounces 
of  brandy  in  doses  of  half  an  ounce  every  hour.  No  effect  was  pro- 
duced on  the  general  health  and  feelings,  and  the  usual  employments 

were  followed  except  on  the  last  day  of  the  experiment,  when  M 

was  bustling  about  in  a  great  state  of  excitement,  packing  up  to  leave 
for  a  country  holiday. 

The  analysis  of  the  urine  was  as  follows : 


Date. 

Quantity  in 
cubic  cen- 
timetres. 

Specific 
gravity. 

Urea  in 
grammes. 

Chlorideof 
sodium  in 
grammes. 

l-el 

.H-e  ~ 

Ills 

::  «  I* 
02        SO 

I'liosphoric 
acid  in 
grammes. 

Uric  acid  in 
grummes. 

August  18,      ... 

1,520 

1.013 

30.465 

5.320 

2.210 

1.299 

.008 

"       20,      ... 

910 

1.025 

33.077 

6.370 

2.375 

1.474 

.259 

«       21,     ... 

1,070 

1.022 

32945 

6.687 

2.246 

1.637 

.193 

"       22,     ... 

1,000 

1.021 

23.735 

6.750 

1.897 

1.440 

.135 

"       23,     ... 

1,310 

1.015 

25.097 

7.205 

1.649 

1.061 

.196 

"       24,     ... 

1,530 

1.021 

41.867 

9.945 

3.064 

2.203 

.390 

One  day  was  an  interval  in  the  experiment,  and  only  the  usual 
amount  of  daily  diet,  without  extra  alcohol,  was  taken,  when  the 
numbers  stand  as  follows : 


ALCOHOL. 


207 


a  , 

0 

a 

Date. 

'%  2"^ 
=  3  = 

Specific 
gravity. 

Urea  in 
grammes. 

Chloride  of 
sodium  in 

grammes. 

S52 

iii 

=  =  ^ 

"E.—  5 

K'C  S 
=  5  L- 

!j 

<§5" 

CO  M 

£   * 

&  *° 

August  19,      ... 

920 

1.026 

35.88 

5.750 

2.374 

1.904 

.281 

It  is  very  clear  from  these  observations  that  alcohol  taken  in 
the  dram-drinking  fashion — namely,  in  small  divided  doses — by 
no  means  increases  metamorphosis.  It  rather  tends  to  diminish 
it,  so  that  during  the  first  five  days  quoted  the  mean  quantity  of 
urea  excreted  is  29.063  instead  of  31.671  grammes.  And  this 
diminution  is  not  sudden  or  immediate,  but  is  more  and  more  for 
a  certain  period,  till  the  retention  reaches  a  point  at  which  a  crit- 
ical evacuation  takes  place  in  healthy  persons. 

This  evacuation  may  take  place  in  consequence  of  the  alcohol 
being  left  off,  as  may  be  observed  on  the  day  of  interval.  Or 
again  if  may  result  from  increased  exertions  and  unwonted  expen- 
diture of  nervous  energy,  as  may  be  noticed  in  the  last  day  of  the 
experiment.  In  neither  case  does  the  amount,  even  of  the  urea, 
replace  the  amount  arrested  during  the  days  of  arrest ;  and  the 
phosphates  are  still  less  unable  to  make  up  their  lost  figures  in 
the  ledger. 

It  cannot  be  concealed  then,  that  even  without  at  all  infringing 
on  high  health,  alcohol  in  small  divided  doses  and  between  meals, 
dram-drinker's  fashion,  deranges  the  metamorphosis  of  the  tissues, 
and  in  the  direction  of  arrest.  And  persistence  in  the  habit  must 
lead  in  the  end  to  permanently  diminished  organization,  degener- 
ation, atrophy.  Just  as  a  disused  limb  wastes  away,  so  must  the 
unrenewed  tissues  die  off  gradually,  till  they  become  unequal  to 
the  support  of  a  healthy  man's  existence. 

The  first  action  of  alcohol,  then,  is  on  the  stomach,  enabling 
more  food  to  be  digested,  and  enhancing  the  origination  of  force. 
But  if  advantage  be  not  taken  of  this  first  action,  its  secondary 
effect  is  a  diminution  of  the  vital  functions  in  general  and  of 
digestion  among  their  number. 

It  might  be  suggested  that  the  subject  of  the  experiments  was 
so  little  used  to  stimulants  that  an  abnormal  effect  might  be  pro- 
duced upon  him  by  them,  but  that  is  rendered  unlikely  by  the 


208 


SPECIAL    DIETETICS    OF    HEALTH. 


succeeding  observation  on  a  person  whose  habits  may  be  described 
as  closely  verging  on  "full  living:" 

Experiment  III. — C ,  aged  43,  healthy,  though  not  muscularly 

robust,  of  regular  life  and  habits,  took  daily  during  the  days  named 
in  the  table  a  quantity  of  food  proportioned  to  appetite,  viz.,  about  a 
pound  and  a  half  of  meat,  half  a  pound  of  bread,  a  pint  and  a  half 
of  tea,  with  milk,  sugar,  butter,  sauces,  etc.,  q.  s.,  half  a  pint  of  water, 
and  from  five  to  seven  glasses  of  port  or  sherry,1  care  being  always 
taken  not  to  annoy  the  temper,  and  so  nullify  the  experiments,  by 
overstrictness. 


Quantity  in 
cubic  cen- 
timetres. 

Specific 
gravity. 

Urea  in 
grammes. 

Chlorideof 
sodium  in 
grammes. 

Sulphuric 
acid  in 
grammes. 

Phosphoric 
acid  in 
grammes. 

Uric  acid  in 
grammes. 

Amount  of  urine  and 

of  its  several  parts, 

made  in  fifteen  days, 

in     perfect     health 
and  on  usual  diet,  . 

18,800 

1.022 

493.852 

137.655 

Do   in  fourteen  days,2 

26.487 

27.683 

3.839 

Mean  daily  amount,  . 

1,253 

1.022 

32.923 

9.177 

1.891 

1.977 

.274 

The  effect  of  taking  in  addition,  between  meals,  a  moderate  quan- 
tity of  alcohol  in  divided  doses,  is  shown  in  the  following  table : 


Date. 

Quantity  in 
cubic  cen- 
timetres. 

Specific 
gravity. 

Urea  in 
grammes. 

Chloride  of 
sodium  in 
grammes. 

u        • 

'£  S3  QJ 

2'-5a 

m 

<K       tao 

Phosphoric 
acid  in 
grammes. 

Uric  acid  in 
grammes. 

Daily  quantity 
of  best  French 
brandy  taken 
between  meals. 

Nov.  16, 

1,180 

1.021 

30.090 

11.210 

1.954 

1.770 

trace. 

3J  fluid  ounces. 

"      19, 
"     22, 

1,800 
1,150 

1.013 
1.025 

28.854 
32775 

9.900 
12075 

1.906 

1.800 

.258 

8       "         " 
71     «         <( 

«     23, 

980 

1  025 

27.930 

9.310 

.  .  . 

7£     "         " 

Dec.     3, 

1,060 

1.023 

28.620 

9.540 

1.785 

1.696 

.339 

3       "         " 

"       5, 

1,320 

1019 

30.875 

9900 

1.865 

1.980 

.330 

8       "         " 

"       6, 

1,110 

l.OJl 

30.025 

9.435 

1.713 

1.665 

.299 

8       "         " 

1,180 

1.020 

30.208 

9.440 

1.586 

1.652 

.343 

4       u         a 

1  Which  may  be  reckoned  to  contain  from  33  to  35  per  cent,  of  proof  spirit. 

2  Of  one  day  the  record  was  imperfect,  the  sulphuric  acid,  phosphoric  acid, 
nnd  uric  acid  not  having  been  weighed. 


ALCOHOL.  209 

It  is  very  clear  from  these  figures  that  vital  metamorphosis,  as 
evidenced  by  the  amount  of  the  principal  solids  of  the  urine,  is"  dimin- 
ished by  thus  taking  more  alcohol  than  the  healthy  instinct  prompts, 
even  in  a  person  used  to  the  full  quantity  that  temperance  permits. 
Not  only  are  the  whole  mean  amounts  low,  but  on  no  day  do  they 
come  up  to  the  average.  The  only  exceptions  are  the  chloride  of 
sodium,  which  is  slightly  increased,  by  what  agency  I  cannot  tell,  and 
the  uric  acid,  whose  augmentation  is,  probably  with  justice,  considered 
an  indication  of  an  approaching  abnormal  state.  It  may  be  remarked 
that  a  greater  quantity  of  brandy  than  that  recorded  above  spoiled 
the  appetite  and  prevented  the  usual  diet  being  taken  with  pleasure. 
I  considered  that  this  would  nullify  the  experiments  as  representing 
the  effects  of  alcohol  in  health,  for  it  placed  the  body  in  an  abnormal 
state,  and  I  therefore  discontinued  them  for  a  time. 

The  only  marked  effect  of  the  quantity  taken  on  the  full  days, 
was  a  certain  degree  of  insensibility  of  the  facial  skin  to  changes 
of  temperature ;  the  fire  did  not  scorch,  and  the  east  wind  did  not 
chill.  So  that  probably  some  temporary  power  of  resistance  to 
external  influences  was  gained,  to  be  followed  by  reactionary  sen- 
sitiveness. 

Let  as  observe  now  the  effects  of  spirituous  liquors  taken  in 
great  excess,  namely,  in  quantity  sufficient  to  destroy  the  natural 
sensitiveness  to  mental  emotion  : 

Experiment  IV. — Letitia ,  a  healthy  prostitute  aged  23,  ac- 
quired the  habit,  during  a  year  of  her  being  on  the  town,  of  frequent 
tippling  to  drown  care.  Standing  by  her  bed  at  home  on  August  14, 
she  suddenly  fell  on  it,  not  losing  her  senses,  but  having  complete 
paralysis  of  the  right  leg  and  arm,  without  a  fit.  On  her  admission 
to  a  hospital  two  days  afterwards,  the  power  had  returned  in  a  great 
measure  to  the  limbs,  but  the  right  lingual  and  facial  muscles  were 
still  quite  paralytic.  As  far  as  one  could  judge  by  external  phenom- 
ena, all  the  viscera  except  the  brain  were  in  a  healthy  state,  and  she 
showed  no  signs  of  hysterics.  She  stayed  in  the  hospital  till  Septem- 
ber 6,  when  she  was  offered  a  place  as  servant,  and  a  slight  impedi- 
ment to  speech  remaining  I  considered  not  sufficient  reason  for  her 
passing  over  so  good  a  chance  of  bettering  her  social  state.  During 
the  time  she  was  under  observation  no  drugs  were  prescribed  for  her; 
she  lay  on  her  bed  the  greater  part  of  the  day,  and  sauntered  about 

14 


210 


SPECIAL    DIETETICS    OF    HEALTH. 


the  ward  and  garden  the  rest ;  she  was  kept  on  broth  diet,1  and  on 
and  after  August  30,  three  ounces  of  brandy  were  allowed  daily. 
The  amount  of  urine  and  of  its  chief  constituents  excreted  by  her  on 
all  the  days  when  circumstances  allowed  it  to  be  all  collected,  is  shown 
in  this  table : 


Date. 

Quantity  in 
cubic  cen- 
timetres. 

Specific 
gravity. 

Urea  in 
grammes. 

Chloride  of 
sodium  in 
grammes. 

Sulphuric 
acid  in 
grammes. 

Phosphoric 
acid  in 
grammes. 

August    17, 

252 

1.018 

5915 

1  389 

? 

.409 

«          19, 

880 

1.006 

12.729 

4.400 

? 

.396 

"          20, 

240 

1.014 

4.529 

2.040 

? 

none. 

«          21, 

270 

1.007 

3.429 

.337 

.206 

.061 

"         22, 

360 

1.011 

5.280 

2.340 

.212 

a  trace. 

"         23, 

1,000 

1.007 

15.353 

3.500 

.871 

.540 

"         24, 

1,280 

1.007 

14.504 

4.480 

.715 

a  trace. 

"         27, 

570 

1.008 

9.405 

1.425 

.436 

u  trace. 

"         28, 

1,030 

1.007 

10.979 

3.862 

.596 

.404 

"         29, 

730 

1.010 

9.252 

3.285 

.423 

a  trace. 

"         30, 
September  1, 
2, 
3, 
4, 
5, 

1,320 

1.008 

13645 

5.120 

1.039 

7.42S2 

.790 

? 
? 

.162 

1,650 

1.008 

22.027 

1.358 

900       i  1.010 

13231 

2.925 

The  metamorphic  organs  of  this  girl  were  clearly  in  a  most 
perilous  condition.  So  little  phosphorus  was  excreted  that  the 
nervous  system  can  have  been  hardly  renewed  at  all.  Sometimes 
not  more  than  a  tenth,  generally  about  a  third,  and  occasionally 
half,  of  the  due  proportion  of  urea  appeared  in  the  urine.  When 
as  much  as  half  of  the  proper  quantity  of  urea  was  formed,  there 
was  an  extraordinary  gush  of  the  aqueous  constituent  accompany- 
ing it.  But  at  other  times  the  total  bulk  of  the  renal  discharge 
was  very  deficient.  The  habits  of  the  urinary  department  in  the 
patient's  economy  closely  approach  to  those  which  we  find  in  that 
peculiar  raetamorphic  (or  functional)  disease  of  the  nervous  sys- 

1  Tea,  2  pints,  with  3  ozs.  of  milk,  and  sugar  q.s.     Bread,  12  ozs  ;   butter, 
f  oz. ;  broth,  1  pint  with  4  ozs.  of  boiled  meat;  gruel,  1  pint. 

2  There  was  a  suspicion  that  on  this  day  the  patient  had  surreptitiously 
taken   a  dose  of  Epsom  salts.     On  the  next  two  days  the  catarnenia  were 
present  for  a  short  time  as  in  anaemic  women. 


ALCOHOL.  211 

tern,  the  various  symptoms  of  which  we  roughly  class  as  "  hys- 
teria." If  her  family  had  been  cursed  with  the  damnosa  hereditas 
of  that  disease,  she  would  most  probably  now  have  developed  it. 
Sydenham  shrewdly  observes  that  if  there  is  any  difficulty  in 
coming  to  the  diagnosis  between  hysteria  and  other  possible  causes 
of  ailment  in  a  particular  case,  two  questions  answered  affirma- 
tively are  enough  to  decide  in  favor  of  the  former,  viz. :  "  Do 
weariness  and  worry  especially  excite  the  symptoms?"  and  "Does 
the  patient  make  sometimes  an  unusual  quantity  of  pale  urine?" 
— an  instance  thus  of  how 


Old  experience  doth  attain 

To  something  of  prophetic  vein  ; 


for  those  are  the  very  hooks  on  which  the  most  advanced  science 
of  the  present  day  would  hang  all  the  pathology  of  hysteria.  For 
it  holds  it  to  be — 1 .  A  disease  of  the  nervou's  system ;  2.  A  dis- 
ease of  an  exhausted  nervous  system;  and,  3.  A  disease  in  which 
an  exhausted  nervous  system  fails  to  complete  the  evacuation  of 
the  debris  of  metamorphosis — the  very  points  made  in  Sydenham's 
aid  to  diagnosis. 

In  the  following  instance  alcohol,  acting  on  a  predisposed  per- 
son, produced  marked  hysteria,  and  was  identified  as  the  guilty 
a^cnt  by  the  disease  ceasing  on  its  being  left  off:  A  clergyman's 
wife,  of  a  refined  sensitive  nature,  became  subject  to  attacks  of 
nervous  sobbing  and  depression  of  spirits,  especially  during  change- 
able weather.  She  also  frequently  vomited  her  food  immediately 
it  was  swallowed,  and  at  last  entirely  lost  the  tone  of  her  voice, 
being  unable  to  speak  above  a  whisper  when  under  the  excitement 
of  a  consultation  with  her  physician ;  but  yet  she  had  a  brazen- 
faced repellent  kind  of  manner  which  sat  very  oddly  on  a  really 
modest  Christian  lady.  Long  and  ingeniously  did  she  elude  the 
discovery  that  she  was  given  to  secret  dram-drinking,  but  was  at 
last  persuaded  to  place  herself  under  the  care  of  a  kind  Quaker 
couple,  who  saw  that  she  had  no  intoxicating  liquor  for  two 
months.  All  the  aphonia,  vomiting,  and  other  hysterical  symp- 
toms went  away  during  this  time,  and  it  is  believed  have  not  re- 
turned. Such  is  the  most  usual  effect  produced  on  a  woman,  pre- 
viously healthy,  by  frequent  small  doses  of  alcohol.  She  becomes 

1  Sydenham,  Dissert.  Epistol.  de  Affectione  Hysterica.  sec.  78.  * 


212  SPECIAL    DIETETICS    OF    HEALTH. 

hysterical ;  but  rarely  does  she  get  delirium  tremens  from  it  alone. 
That  form  of  nervous  tornado  attacks  the  female  sex  only  in  old 
age,  when  the  feminine  characteristics  are  annulled,  or  in  conse- 
quence of  intense  mental  excitement.  But  when  it  does  attack 
them,  they  are  very  apt  to  sink  under  it.  (As  e.  g.,  an  upper 
housemaid  at  a  large  hotel,  falsely  accused  of  theft,  died  under  my 
care  at  St.  Mary's  in  two  days  of  furious  delirium  tremens.  Her 
boxes  were  filled  with  empty  brandy  bottles,  though  she  had  never 
shown  signs  of  drinking.)  In  man  delirium  tremens  is  much 
more  readily  induced,  and  hysteria  only  exceptionally.  It  is  not 
necessary  to  do  more  than  allude  to  the  well-known  deficiency  of 
lx)th  the  watery  constituent  and  the  phosphatic  salts  of  the  renal 
secretion  in  these  cases  during  the  violence  of  the  disorder,  as  that 
point  has  been  ably  illustrated  by  Dr.  Bence  Jones  in  his  paper 
on  the  subject.1  But  it  is  worth  while  to  draw  attention  to  the 
fact,  that  exactly  contemporaneous  with  a  restoration  of  health  is 
the  reappearance  in  the  urine  of  the  phosphates  in  his  third  case. 
It  is  possible  that  the  delirium  may  be  a  clearing  storm,  the  con- 
sequence of  which  is  a  return  to  the  normal  state  of  phosphatic 
metamorphosis  sooner  than  happens  in  cases  where  the  delirium 
does  not  occur.  For  it  may  be  observed  in  Experiment  III  in 
this  chapter,  where  there  was  no  critical  paroxysm,  that  the  phos- 
phates remain  almost  wholly  absent  from  the  analysis,  in  spite  of 
apparently  recovered  health.  And  this  accords  with  the  familiar 
fact  that  hysteria  is  a  much  more  obstinate  disease  than  paroxys- 
mal alcoholism. 

Allusion  has  been  made  to  the  use  of  alcohol  as  a  protection,  in 
cases  of  traumatic  injury  and  mental  exhaustion,  against  the  per- 
nicious over-activity  of  the  nervous  system.  And  it  is  possible, 
too,  that  it  may  oppose  the  entrance  of  morbid  and  other  poisons 
by  retarding  absorption,  as  is  indicated  in  its  popular  reputation 
as  a  preservative  against  malaria  and  noxious  fumes.  But  if  it 
has  failed  in  its  mission,  if  the  wound,  or  the  worry,  or  the  virus 
have  been  too  strong  for  their  force  to  be  broken  by  such  a  buffer, 
then  there  seems  some  doubt  whether  the  patient  is,  or  is  not, 
worse  off  for  having  taken  it.  Just  as  after  an  operation  under 
anaesthetics  there  may  in  some  cases,  be  a  similar  doubt.  But  an 

1  Med.  Chir.  Transactions,  vol.  xxx,  p.  21. 


ALCOHOL.  213 

habitual  tippler,  as  distinguished  from  an  occasional  exceeder,  is 
certainly  in  more  danger  from  disease  than  a  temperate  man  under 
the  same  circumstances.  The  venerable  Dr.  Christison,  in  a  letter 
dated  1870,  writes:  "How  can  we  ever  hope  to  express  numeri- 
cally the  influence  of  drunkenness  (habitual)  in  aggravating  the 
mortality  from  fevers,  cholera,  dysentery,  and  other  zymotics?  .  .  . 
Let  me  conclude  with  one  illustrative  fact.  I  have  had  a  fearful 
amount  of  experience  of  continued  fever  in  our  infirmary  during 
many  an  epidemic,  and  in  all  my  experience  I  have  only  once 
known  an  intemperate  man  of  forty  or  upwards  recover.  He  \va- 
the  exceptio  qua1  probat  regulam"1 

The  action  of  alcoholic  drinks  upon  the  internal  viscera  seems 
to  be  an  immediate,  and  if  continued,  an  habitual  paralysis  of  the 
vaso-motor  nerves;  as  may  be  seen  by  the  naked  eye  in  the  flushed 
face  of  the  drunkard.  Venous  congestion  follows,  and  the  glandu- 
lar structure  becomes  loaded  with  black  devitalized  blood.  The 
presence  also  of  the  alcohol  in  the  blood  further  diminishes  the 
rapidity  of  nutrition  and  disintegration,  arid  consequently  dimin- 
ishes the  dependent  functions  of  elimination  and  calorification,  and 
as  long  as  it  remains  in  the  body.2 

Secretion  is  retarded,  and  the  organic  material  which  ought  to 
form  it,  grows  into  a  semi-organic  morbid  tissue,  bloodless,  insen- 
sitive, useless,  which  we  call  cirrhosis.  This  gradually  dries  up 
and  shrinks,  like  a  scar,  and  thus  puckers  up  the  gland  it  is  in, 
forming  "nutmeg"  liver,  "granular"  kidney,  "fibrosis"  and 
"  chronic  condensation  "  of  lung,  thickening  of  the  mucous  mem- 
branes in  larynx  and  elsewhere,  and  arterial  degeneration. 

In  the  case  of  the  liver  no  pathologists  ever  seem  to  have  ex- 
pressed a  doubt  as  to  the  influence  of  alcohol  upon  it;  but  in  re- 
gard to  the  kidneys  there  has  been  a  controversy  as  to  whether 
the  prevalence  of  B right's  disease  among  the  working  cla-^cs 
should  not  rather  be  attributed  to  their  exposure  to  weather:  and 
Dr.  Dickinson,  of  St.  George's  Hospital,  has  contributed  some- 
what to  relieve  alcohol  of  exclusive  responsibility.  He  compares 

1  Second  Annual  Report  of  the  State  Board  of  Health  of  Massachusetts,  Jan.. 
1871,  p.  339. 

2  Dr.'^.S.  Davis,  in  the  Chicago  Medical  Examiner,  Sept.,  1867,  brings 
evidence  from  sphygmographic  observations  as  to  the  depressing  influence  of 
alcohol  upon  the  circulation. 


214  SPECIAL    DIETETICS    OF    HEALTH. 

numerically  the  frequency  of  renal  degeneration  in  the  bodies  of  a 
class  especially  open  to  the  temptation  of  excess — consisting  of 
pot-boys,  publicans,  spirit-dealers,  cellar-men,  waiters,  etc. — with 
what  was  found  by  post-mortem  examination  in  an  equal  number 
of  other  hospital  patients  of  various  occupations.  The  kidneys 
were  reported  free  from  disease  in  almost  exactly  the  same  number 
of  the  two  classes.1  Now  the  principal  flaw  in  this  argument  is 
that  many  of  those  whose  trade  is  among  spirits  are  nevertheless 
very  temperate  persons  (my  own  wine  merchant  takes  only  a 
glass  of  currant  wine  with  his  dinner);  and  "barmaids"  and 
"  waiters,"  included  in  the  black  list,  are  only  exceptionally  in- 
temperate. And  we  must  add  to  this  that  several  of  the  employ- 
ments of  the  other  class  are  really  more  likely  to  lead  to  tippling 
than  the  trade  in  alcohol  is.  (Who,  for  example,  ever  knew  a 
" traveller"  who  was  not  obliged  to  liquor  with  his  customers,  as 
part  of  his  daily  work  ?)  Dr.  Dickinson  rightly  points  out  that 
the  non-alcoholic  class  are  much  more  exposed  to  the  weather 
than  the  others,  and  this  noxious  influence,  balancing  to  an  un- 
known degree  the  influence  of  alcohol,  vitiates  the  value  of  the 
statistics.  The  only  fairly  reckoned  non-alcoholic  persons  are 
total  abstainers,  who  now  are  to  be  found  in  considerable  numbers, 
and  might  be  compared  justly  with  the  rest  of  the  population. 
While  I  think  Dr.  Dickinson  to  be  right  in  his  general  conclu- 
sions, as  also  in  attributing  greater  importance  than  some  others 
do  to  cli^natic  influences  in  renal  degeneration,  I  do  not  consider 
that  his  statistics  bear  him  out.  They  are  too  raw.  At  present, 
it  seems  to  rne  that  the  physiological  knowledge  which  we  possess 
of  the  influence  of  alcohol  in  health  is  a  more  accurate  guide  to 
its  morbid  consequences  than  any  statistics  yet  put  before  the 
world.  It  is  impossible  to  trust  a  patient's  statement  as  to  drink- 
ing habits,  and  there  is  no  other  attainable  datum  for  classifying 
him  as  temperate  or  the  reverse. 

The  "  chronic  condensation  "  of  the  lung  induced  by  alcohol 
seems  to  be  a  form  of  atrophy  not  dissimilar  to  that  brought  on 
by  the  presence  of  fluid  in  the  pleura,  emphysema  or  frequent 
bronchitis.  It  arises  from  the  imperfect  functioning  of  the  lung 

1  Med.  Chir.  Transactions,  vol.  Ivi,  p.  51  (1873). 


ALCOHOL.  215 

tissue,  which,  like  all  imperfectly  functioning  tissues,  becomes  less 
vitalized,  less  fully  renewed  by  interstitial  metamorphosis. 

This  imperfect  functioning  is  a  necessary  consequence  of  the 
limitation  of  the  aerating  area  of  the  lungs  by  the  sanguineous 
congestion  which  has  been  already  alluded  to.  The  extent  to 
which  the  habitual  congestion  of  the  tissue  and  limitation  of  area 
is  carried,  even  without  apparent  injury  to  health,  is  proved  by 
the  diminution  of  the  "  vital  capacity  "  for  air  as  shown  by  the 
spirometer;  no  drinker  of -drams  between  meals  can  ever  come 
nearer  than  20  or  30  cubic  inches  to  the  amount  of  air  the  lungs 
ought  to  expire  in  health.  Yet  so  little  does  he  notice  this  short- 
ening of  wind,  that  it  is  no  uncommon  thing  at  insurance  offices 
(when  they  use  the  spirometer)  to  have  proposers  make  their  ap- 
pearance stating  that  they  have  never  been  seriously  ill,  and  never 
felt  better  than  at  that  moment,  who  are  caught  out  as  dram- 
drinkers  by  the  failure  at  the  spirometer.  The  partial  condensa- 
tion of  the  lung  from  this  cause  is  not  so  likely  to  lead  to  fibrosis 
as  to  inelasticity  and  fatty  degeneration  of  the  tissue.  The  sur- 
face of  the  organ  when  examined  post-mortem  takes  the  mark  of 
the  finger  pressed  upon  it,  is  saturated  with  moisture,  hardly 
crepitant  at  all  and  hardly  able  to  swim  in  water.  But  it  does 
not,  as  a  rule,  exhibit  the  whitish  gristly  stripes,  which  squeak 
under  the  scalpel,  and  consist  of  a  dense  fibrinous  substance,  nor 
the  contracting  scar-like  depressions  which  characterize  chronic 
pneumonia.  Nor  does  it  suppurate,  I  believe. 

The  chronic  condensation  of  the  pulmonary  tissue  is  partly  the 
cause  of  the  wheezy  broken  speech  of  the  intemperate;  but  this 
also  depends  very  often  on  an  irregularly  thickened  condition  of 
the  laryngeal  and  tracheal  mucous  membrane,  following  an  habit- 
ual sluggish  circulation  through  its  capillaries. 

The  last-named  injury  to  health  from  excess  in  alcohol,  arterial 
degeneration,  is  perhaps  the  most  doubtful.  It  is  so  common  in 
all  classes  that  it  is  very  difficult  to  arrive  at  direct  proof  of  the 
tendency  to  it  being  increased  by  this  cause.  The  principal  fact 
in  evidence  is  that  it  is  more  common  among  men  than  among 
women,  and  so  is  also  drinking.  But  when  I  review  the  physi- 
ological instead  of  the  statistical  aspect  of  the  argument,  I  can 
hardly  hesitate  to  assign  a  serious  influence  in  the  induction  of 
the  lesion  to  alcohol.  Alcohol,  which  lowers  all  the  vital  actions 


216  SPECIAL    DIETETICS    OF    HEALTH. 

we  know  of,  is  just  the  agency  one  would  think  most  pernicious, 
in  replacing  elastic  and  fibrous  tissue  by  that  of  an  inferior  grade, 
friable  and  unorganized.  Under  arterial  degeneration  there  ranks 
itself  a  long  list  of  evils,  of  which  those  best  known  by  name  to 
the  public  are  apoplexy  and  dropsy,  justly  reputed  to  be  due  to 
drink.  To  the  medical  mind  they  naturally  suggest  themselves, 
and  it  is  needless  to  enumerate  them  here. 

When  we  consider  how  completely  the  whole  body  is  saturated 
by  alcohol  taken  in  any  marked  excess,  we  cannot  be  surprised 
to  hear  that  the  evil  effects  of  it  are  not  rarely  transmitted  to  future 
generations.  In  a  recent  work,1  Dr.  Auguste  Voisin  has  pub- 
lished the  results  of  an  investigation  into  the  consequences  to  the 
children  of  the  father's  addiction  to  intoxication,  and  very  terrible 
they  are.  In  seventeen  cases  of  the  bpark  of  life  being  struck 
during  the  drunkenness  of  the  father,  infantile  convulsions  caused 
the  child's  death  in  eleven.  Less  fortunate  were  those  who  sur- 
vived ;  three  were  idiots,  two  were  epileptic,  and  one  the  subject 
of  chronic  myelitis.  Of  course  this  list  is  not  a  full  statistical 
representation  of  the  consequences  of  the  parents'  excess,  for  those 
who  escape  do  not  become  subject  to  medical  examination,  and 
there  is  no  means  of  knowing  how  many  they  may  be.  But  it  is 
a  very  terrible  list  for  all  that. 

Chronic  alcoholism  in  the  parents  is  still  more  cursed  than  the 
action  of  the  acute  condition  above  alluded  to ;  for  it  does  not  cut 
off  the  victims  by  a  sudden  blow,  but  allows  them  to  live  on  in 
indefinite  wretchedness.  Of  eighteen  cases  traced  by  Dr.  Voisin, 
eight  were  idiots  and  ten  were  epileptic. 

Having  attributed  so  many  ill  effects  to  alcohol,  it  is  but  fair  to 
inquire  whether  something  may  not  be  found  as  a  set-off  beyond 
the  mere  dietetic  use  mentioned  at  the  beginning  of  the  essay.  If 
it  causes  disease,  may  it  not  also  prevent  ?  There  is  a  prevalent 
notion  that  it  excludes  the  formation  of  tubercle.  The  fact  given 
in  proof  of  the  notion  is  that  publicans  do  not  often  die  of  phthisis, 
and  Dr.  Walshe  indorses  the  truth  of  it.2  My  own  limited  ex- 
perience certainly  confirms  that  observation,  but  yet  it  goes  rather 
to  show  that  their  not  dying  of  phthisis  depends,  not  on  the  ex- 

1  L'Alcoolisme  et  la  Sequestration  des  Ali^nes,  p.  3 

2  Diseases  of  the  Lungs,  4th  ed.,  p.  453. 


ALCOHOL.  217 

elusion  of  tubercle,  but  on  the  postponement  of  the  second  stage  of 
the  malady.  The  tubercles  do  not  so  soon  break  down  into  sup- 
puration. A  publican  who  was  a  patient  of  mine  for  several  years, 
off  and  on,  died  of  hereditary  consumption  at  a  much  later  period 
than  the  rest  of  his  family,  and  indeed  after  he  had  ceased  to  be  a 
publican;  but  the  first  development  took  place  while  he  was  ac- 
tively engaged  in  aiding  the  spirit-trade  by  precept  and  example. 
Nevertheless,  it  is  something  gained  if  the  softening  of  the  tuber- 
cles is  in  any  way  arrested  by  the  use  of  alcohol,  even  though  the 
arrest  should  be  followed  by  a  more  general  break-up  in  the  end. 
But  the  use  of  alcohol  in  the  treatment  of  disease,  as  contradis- 
tinguished from  its  prevention,  belongs  to  the  next  section,  where 
the  subject  shall  be  resumed. 

The  dietetic  use  of  small  quantities  of  alcohol  tends  to  ward  off 
morbid  conditions  which  are  secondary  upon  atonic  dyspepsia; 
and  therefore  it  may  be  credited  with  the  prevention  of  anaemia, 
emaciation,  premature  old  age  from  worry,  melancholia,  sleepless- 
ness, and  any  other  possible  consequences  of  that  form  of  indiges- 
tion in  a  considerable  section  of  the  population.  Our  weaker 
brethren  (yfivTepss  apyot}  "  slow  stomachs,"  as  the  poet  with  anatom- 
ical precision  calls  them)  owe  it  to  alcohol,  and  often  to  alcohol 
only,  that  their  weakness  does  not  become  disease.  Very  likely 
the  dura  messorum  ilia  are  better  without  it,  so  long  as  they  con- 
tinue tough ;  but  how  long  is  that  in  this  age  of  feverish  cultiva- 
tion of  the  soul  at  the  expense  of  the  body  ?  And  ill  indeed  can 
the  world  spare  many  of  those  weaker  brethren,  who  without 
alcohol  would  be  wailing  invalids  instead  of  the  pillars  of  the 
country. 

The  form  in  which  the  product  of  alcoholic  fermentation  is 
presented  to  the  digestive  organs  is  far  from  being  indifferent. 
The  various  methods  of  making  it  agreeable,  or  convenient,  or 
cheap,  offer  an  article  varying  from  one  little  distant  from  a  poison 
to  one  where  all  the  advantages  are  obtained  with  an  inapprecia- 
ble risk  of  disadvantage.  The  most  wholesome  of  these  beverages 
are  the  immediate  results  of  fermentation  in  its  simple  integrity, 
or  with  the  addition  of  water  only.  But  it  is  very  seldom  that 
the  saccharine  matters  used  are  good  enough,  or  the  makers  skil- 
ful enough,  and  honest  enough,  so  to  manufacture  their  liquors  as 
to  be  agreeable  to  the  palate,  or  capable  of  remaining  agreeable 


218  SPECIAL    DIETETICS    OF    HEALTH. 

for  a  sufficient  time.  And,  therefore,  the  pure  but  nasty  liquor 
has  to  be  distilled ;  and  the  distillation  partly  concentrates,  but 
principally  newly  develops  the  noxious  "fusel  oil,"  the  bug- 
bear of  the  distillers.  All  new,  and  therefore  all  cheap,  spirits 
are  made  by  it  nauseous  to  the  unaccustomed  palate,  and  deleter- 
ious to  the  health. 

Of  pure  wine  the  ripening  is  soon  effected,  and  after  a  year  or 
so,  the  palate  only  has  to  be  consulted  as  to  the  time  of  consump- 
tion. But  it  is  not  so  with  vintages  whose  peculiar  flavors  it  is 
desirable  to  preserve  by  retaining  unfermented  a  portion  of  the 
sugar,  and  the  oil  of  the  grape-stone.  Unless  these  wines  are 
"  fortified  "  with  spirit,  they  decay  prematurely,  grow  mouldy  or 
"  bitter,"  rancid,  and  sour.  Now,  if  pure  alcohol  or  old  French 
brandy  were  used  for  this  purpose,  little  harm  would  be  done, 
but  the  manufacturers  commonly  employ  for  cheapness  new  po- 
tato or  corn  spirit,  loaded  with  fusel  oil ;  and  then  the  only  chance 
for  the  consumer  getting  a  wholesome  beverage  is  to  keep  it  at  the 
risk  of  deterioration,  till  it  has  become  a  costly  luxury.  Woe  to 
the  drinkers  of  cheap  Peninsular  wines  and  their  imitations. 

There  has  been  some  question  lately  as  to  how  "purity"  in 
wine  is  to  be  defined  in  legislative  or  other  literature.  Is  it  an 
adulteration  to  add  alcohol  to  wine?  I  do  not  see  how  it  can  be 
considered  so ;  and  if  it  were,  the  proof  of  the  addition  of  one  of 
the  normal  constituents  of  the  liquid  would  be  difficult.  Just  as 
it  is  difficult  to  decide,  except  by  a  conventional  standard,  that 
the  water  in  our  milk  does  not  come  from  the  cow.  And  conven- 
tional standards  are  not  strict  justice.  But  if  the  offence  were 
held  to  consist  in  "fuselling"  wine,  there  would  be  but  little  im- 
pediment to  our  learning  from  an  analyst  whether  we  had  an  ar- 
ticle fit  for  human  consumption  or  not,  and  also  its  proximate 
commercial  value. 

What  principally  concerns  us  here  is  that  not  all  the  evil  of 
strong  drinks  is  to  be  attributed  to  alcohol ;  and  that  a  man  may 
by  over-indulgence  in  "pineapple  lozenges,"  "pear  drops,"  or 
"  fruity  hardbake,"  made  as  usual  with  the  products  of  the  semi- 
decomposition  of  fusel  oil,  possibly  do  his  health  more  harm  than 
by  visits  to  the  tap-room.1  The  whole  evil  of  drinking  does  not 

1  In  the  Fourth  Annual  Report  of  the  State  Board  of  Health  of  Massachu- 
setts (January,  1873),  mention  is  made  by  Dr.  H.  K.  Oliver  of  two  children 


ALCOHOL.  219 

arise  out  of  fusel  oil ;  for  we  see  the  consumers  of  the  very  sound- 
c.-t  beer  and  wine  often  suffer;  but  that  an  incalculable  addition  is 
made  to  it  thereby  is  beyond  doubt,  and  great  gratitude  is  due  to 
every  one  that  helps  us  to  exclude  it  from  our  beverages. 

There  are  also  doubtless  other  qualities  besides  the  exclusion  of 
fusel  oil  which  may  render  fermented  liquors  wholesome.  Four 
years  ago  there  was  living  at  the  village  of  Menidi,  near  Athens, 
a  priest  90  years  of  age,  who  from  early  manhood  had  consumed 
a  dozen  bottles  of  Greek  wine  a  day,  partly  at  meals,  and  partly 
at  odd  times.1  It  would  be  interesting,  no  doubt,  to  know  the 
structure  of  this  venerable  toper's  kidneys,  as  specimens  of  typical 
development,  but  the  consul  is  probably  right  in  attributing  much 
to  the  quality  of  the  wine,  which  is  preserved  from  chemical 
change  by  means  of  rosin  instead  of  fuselly  spirit.  Rosined  wine 
is  an  acquired  taste;  and  the  British  artist,  when  he  first  quenches 
his  thirst  at  a  Tuscan  farm  or  rustic  inn,  is  apt  to  exclaim  that 
the  landlord  has  drawn  the  wine  in  a  varnish-pot,  and  to  sneer  at 
the  balsamic  and  wholesome  Vino  Vermuth.  But  it  is  a  taste 
well  worth  acquiring  by  thirsty  souls  in  warm  climates,  and  to  be 
patronized  by  philanthropists.  I  understand  that  the  flavor  of 
Vino  Vermuth  is  partly  given  by  wormwood;  and  if  so,  the  ac- 
knowledged wholesomeness  of  the  wine  would  seem  an  answer  to 
M.  Magnan  and  others  who  have  been  trying  to  fix  upon  the  in- 
nocent herb  the  blame  of  what  they  call  "Absinthisme,"  and 
which  is  stated  to  contribute  so  largely  to  the  clegeneracy  of  the 
French  nation.2 

Water,  again,  and  salt  are  directly  antagonistic  to  alcohol  in 
their  physical  action  on  the  animal  body.  They  both,  especially 
the  former,  augment  metamorphosis,  as  the  previously  quoted  re- 
searches of  Dr.  Boecker  fully  show.  Their  presence  therefore  in 
the  wine,  especially  if  they  are  thoroughly  incorporated  with  it 
from  its  first  origin,  cannot  but  be  beneficial.  On  this  ground, 

being  seized,  after  sucking  a  candy  anchor,  with  alarming  sedative  symptoms, 
requiring  active  medical  treatment.  The  flavoring  was  pine-apple  essence 
(butyric  ether). 

1  See  a  letter  from  the  United  States  consul  at  Athens  in  the  Second  Re- 
port of  the  State  Board  of  Health  of  Massachusetts,  p.  258. 

2  Les  diverses  formes  du  delire  alcoolique,  par  le  docteur  Magnan.     Paris, 
1874:  Delahaye. 


220  SPECIAL    DIETETICS    OF    HEALTH. 

the  addition  of  sea-water  to  the  must  (the  marriage  of  Ampelos 
and  Amphitrite  of  the  Greek  gem)  is  a  custom  to  be  highly  com- 
mended. 

Are  there,  against  the  ill  consequences  traceable  to  alcohol,  any 
other  preservatives,  besides  these  found  in  the  liquor  itself? — any 
guardians,  innate  or  acquired,  resident  in  the  body  of  the  con- 
sumer ? 

There  are  probably  few  readers  of  British  literature  who  have 
not  smiled  at  Addison's  light  banter  of  the  amateur  self-doctor, 
who  says  he  commits  an  excess  on  the  first  Monday  in  every 
month  for  the  good  of  his  health.1  But  perhaps  all  are  not  aware 
that  this  is  a  strict  carrying  out  of  the  opinion  deduced  by  the 
ingenious  Sanctorius  from  careful  observations  made  upon  his  own 
person.  He  says  that  "  they  who  use  regular  diet  want  the  ben- 
efit of  those  who  debauch  once  or  twice  a  month."2 

He  does  not  give  it  as  a  popular  notion,  and  it  does  not  appear 
to  have  been  so,  till  attention  was  drawn  to  his  series  of  self-deny- 
ing and  generally  conclusive  experiments,  with  its  portrait  of  the 
author  dining  in  his  scales  opposite  the  title.  But  if  the  previous 
aphorisms  be  read,  it  will  be  seen  that  he  grounds  his  opinion  on 
the  fact,  that  the  weight  of  the  body  is  less  the  next  day  "  without 
any  sensible  evacuation."3  This  merely  implies  that  less  food  has 
been  assimilated,  an  advantage  only  to  those  who  habitually  eat 
too  much.  But  the  author  seems  to  think  that  "  the  corruptible 
body  weigheth  down  the  soul "  in  direct  proportion  to  its  pounds 
and  ounces,  a  most  unphilosophical  superstition.  All  the  possible 
benefit  of  the  monthly  debauch  might  be  gained,  in  certainly  a 
more  dignified  manner,  by  a  day's  fasting. 

The  only  justification  for  an  aphorism  pregnant  with  so  much 
danger  is  the  observation,  which  is  true  enough,  that  occasional 
excesses,  however  much  they  may  disturb  the  functions  at  the  time, 
are  infinitely  less  noxious  than  habitual  dram-drinking.  The 
most  certain  victims  to  alcohol  are  those  who  are  always  sipping, 
though  "  never  drunk  in  their  lives ;"  whereas  we  have  all  of  us 
known  many  a  toper  who  has  attained  a  green  old  age  by  letting 
an  interval  of  recovery  elapse  between  his  bouts  of  riot. 

1  Spectator,  No.  25. 

2  Medicina  Statica,  Apt).  100.     Quinoy's  translation. 
8  Id.,  Aph.  99. 


ALCOHOL.  221 

A  powerful  collateral  preservative  is  the  kidney.  If  this  organ 
acts  well  and  quickly,  above  the  average  of  human  kidneys,  a 
large  proportion  of  the  alcohol  swallowed  passes  away  unchanged 
and  harmless  in  a  short  space  of  time,  as  is  shown  by  the  known 
researches  of  Dr.  Percy,  Mr.  Masing,  and  the  French  physiolo- 
gists, Pen-in  and  Duroy,  who  have  repeated  their  experiments. 
This  peculiarity  probably  distinguishes  those  strange  mortals  who 
never  seem  the  worse  for  anything  they  drink. 

A  further  preservative  against  the  wiles  of  alcohol  is  to  be 
found  in  a  full  aeration  of  the  blood.  Those  who  can  bear  much 
liquor  without  constitutional  effects  have  generally  a  highjvital 
capacity  of  chest  in  proportion  to  their  stature;  whereas  those 
whose  health  is  injured  by  it  fail  to  raise  the  spirometer  to  the 
proper  measure  of  cubic  inches ;  so  that  by  this  means  constitu- 
tions damaged  by  drink  can  be  detected  at  insurance  offices.  It 
may  be  observed  also,  that  a  free  supply  of  fresh  air  during  meals 
modifies  considerably  the  results  of  imprudence. 

§  2.  MORAL  EFFECTS  OF  ALCOHOL. 

As  man  consists  of  mind  as  well  as  body,  it  is  impossible  in 
this  essay  to  omit  all  mention  of  the  moral  effects  of  the  consump- 
tion of  alcoholic  drinks,  though  the  limitation  of  space  prevents 
a  full  discussion  of  the  subject.  All  nations  that  have  led  the 
van  in  the  march  of  civilization,  have  been  addicted  to  drink — 
aye,  and  addicted  to  drunkenness.  The  Jews,  the  Greeks,  the 
Romans,  the  Germans,  the  Swedes,  the  Danes,  not  to  mention  the 
English  all  round  the  globe,  are  amply  attested  by  literature  to 
have  been  distinguished  above  their  contemporaries  in  this  way.1 
It  is  true  that  some  reactionary  races,  famous  as  conquerors,  have 
been  abstinent,  but  they  and  their  faiths  are  dying  out,  and  the 


1  Dr.  Bowditch  contends  that  proneness  to  drunkenness  is  governed  by  cli- 
matic law,  becoming  stronger  in  proportion  to  distance  from  the  equator. 
But  as  he  allows  of  the  influence  of  hereditary  disposition,  the  law  does  not 
guide  us  to  much  inference.  The  widely  dispersed  races  are  not /appreciably 
affected  in  their  habits  by  isothermal  lines.  Facilities  for  growing  the  grape 
depend  doubtless  on  climate,  but  I  think  Dr.  Bowditch's  own  map  and  data 
exclude  its  influence  on  man  in  respect  of  alcohol. —  Third  Annual  Report  to 
State  Board  of  Health  of  Massachusetts. 


222  SPECIAL    DIETETICS    OF    HEALTH. 

coloring  they  have  given  to  civilization  is  even  now  fainter  than 
that  left  by  the  robuster  races  a  thousand  years  before  they  were 
heard  of.  Yet  we  learn  at  the  same  time  from  the  same  impar- 
tial witness,  that  vice,  and  vice  too  of  a  sort  which  is  destructive 
to  the  social  wellbeing  of  a  community,  is  conspicuously  tracea- 
ble on  a  vast  scale  to  strong  drink.  We  read  of  it  in  patriarchal 
times  as  leading  to  a  breach  of  the  instinctive  reverence  due  to 
parents,  then  to  the  vindictive  cursing  of  a  son,  then  to  incest, 
then  to  murder,  and  so  on  in  a  continuous  series  up  to  the  wife- 
beatings  in  yesterday's  police  reports. 

Then,  side  by  side  with  the  innumerable  judges'  charges  and 
prison  reports,  establishing  irrefragably  the  fact  that  by  far  the 
greater  proportion  of  crime  brought  under  notice  is  due  to  drink, 
one  reads  with  astonishment  such  unexpected  revelations  as  those 
contained  in  the  following  letter  from  the  United  States  consul  at 
Copenhagen  to  the  Massachusetts  Board  of  Health.  Mr.  Yeaman 
says,  after  citing  statistical  evidence : 

"  Here  is  a  people  evidently  more  prosperous  than  formerly, 
evidently  using  more  brandy  than  formerly,  and  evidently  less 
given  to  intoxication  than  formerly.  .  .  The  people  here  appear 
so  very  sober,  that  I  have  been  simply  astonished  to  find  how 
much  brandy  they  really  use."1 

It  is  superfluous  to  notice  that  as  intoxication  is  less,  crimes  of 
violence  are  less  also. 

Mr.  Yeaman  goes  on  to  add : 

"  There  is  perhaps  no  country  in  Europe,  except  Prussia,  where 
the  average  standard  of  education  and  intelligence  is  so  high  as  in 
Denmark." 

How  shall  this  conflict  be  reconciled  ?  How  is  it  that  ignor- 
ance, poverty,  and  vice,  which  daily  are  degrading  the  individual 
drinker,  spare  the  community?  Have  the  statisticians  erred  by 
collecting  evidence  only  for  the  prosecution,  and  omitting  a  coun- 
terbalancing class  to  the  criminals?  I  think  so.  The  temperate 
man,  who  takes,  in  proportion  to  his  needs,  fermented  liquors 
with  his  meals,  has  been  put  out  of  sight  altogether.  Yet  is  he 
the  pillar  of  his  country's  prosperity,  prolific,  prosperous,  and 
contented.  It  is  probably  his  increase  in  number  and  power 

1  Second  Annual  Report,  1871. 


ALCOHOL.  223 

which  balances  the  amount  of  vice  and  misery  caused  by  excess  in 
drink.  It  is  not  safe,  then,  for  the  political  economist  to  neglect 
his  interest,  as  would  be  done  by  legislative  measures  tending  to 
make  the  beverages  he  requires  more  difficult  of  attainment,  by 
impediments  to  their  purchase  or  the  enhancement  of  their  price. 
Still  less  is  it  safe  by  social  pressure  to  lead  him  to  banish  the  beer 
jug  or  the  bottle  from  his  table,  and  hide  it  in  secret  cupboards, 
or  to  drive  him  to  sly  grog-shops  between  meals.  He  should 
rather  be  induced  by  the  cheapness  of  wholesome  fermented  liquors 
to  employ  them  for  domestic  use,  and  to  forego  the  dangerous 
product  of  the  still. 

In  Nineveh  of  old  (as  Mr.  Smith  reads  to  us  from  the  arrow- 
head records)  Ishtar,  goddess  of  carnal  love,  behaved  at  one  time 
so  scandalously,  that  the  reigning  sovereign  persuaded  the  heavenly 
powers  to  let  him  banish  her  to  the  nether  world.  Few  that  read 
the  published  translation  in  the  Daily  Telegraph  last  year  (and 
who  did  not  ?)  can  forget  the  picturesque  monotone  in  which  her 
gradual  decay  into  silence  is  narrated  at  solemn  length.  But  no 
sooner  was  she  put  down,  than  matters  essential  to  the  future  con- 
tinuance of  the  race  went  all  wrong,  and  the  frightened  mover  of 
this  early  repressive  bill  was  obliged  to  petition  for  her  return ; 
and  back  again  she  came  in  the  same  tedious  way  that  she  went. 
If  this  is  history,  it  is  a  valuable  experience  ;  if  it  is  a  myth,  a 
prescient  knowledge  of  man's  nature  is  shown,  pregnant  of  warn- 
ing to  the  legislator. 

We  need  not  hesitate  to  transfer  to  the  regulation  of  matters 
connected  with  alcoholic  excess  experience  amply  confirmed  by 
the  history  of  all  ages,  derived  from  another  cognate  temptation. 
The  crimes  attendant  on  both  are  developments  of  selfishness,  and 
of  the  want  of  that  self-restraint  which  we  were  sent  into  the 
world  to  learn,  and  which  a  man  may  fairly  complain  of  a  so- 
called  paternal  legislation  depriving  him  of  the  opportunity  of 
learning. 

But  the  removal  of  the  means  of  excess,  out  of  false  tenderness 
to  the  exceeders,  and  at  the  expense  of  the  temperate,  is  one  thing, 
and  the  repression  of  their  excesses  is  quite  another — nay  more, 
it  is  antagonistic.  Pagan  and  Christian  moralists  have,  perhaps, 
rightly  held  that  of  the  three  main  incentives  to  crime,  malice, 
brutality,  self-indulgence,  the  last  is  the  more  pardonable,  and  in- 


224  SPECIAL    DIETETICS    OF    HEALTH. 

volves  the  least  sinfulness.1  And  so  long  as  law  was  considered 
to  represent  a  vengeful  Deity,  and  to  punish  in  proportion  to  the 
moral  enormity  of  the  sinner,  so  long  was  drunkenness  rightly 
pleaded  in  extenuation  of  offences.  Even  now  in  Italy  it  legally 
mitigates  punishment.  But  I  believe  I  am  correct  in  saying  that 
a  higher  political  education  has  in  our  age  changed  this  view,  and 
the  province  of  law  is  daily  more  and  more  considered  to  be  con- 
fined to  the  protection  of  society,  not  of  God — "  Deorum  offcnsa 
Dlis  euro,"  is  said  not  in  scorn,  but  in  reverent  humility.  Now 
society,  without  a  doubt,  runs  greater  risk  of  damage  by  violence 
at  the  instigation  of  drunkenness  than  at  the  instigation  of  all 
other  incentives  whatever ;  and  therefore  justice  has  advanced  so 
far  as  in  theory  to  hold  it  in  aggravation  of  an  offence.  She  feels 
that  she  ought  to  be  most  a  terror  to  those  from  whom  she  is  in 
greatest  danger.  In  theory,  yes — but  she  has  not  reduced  her 
theory  to  written  rules ;  and  in  practice  we  daily  read  instances 
of  the  medieval  prejudice  prevailing,  and  of  criminals  lightly 
treated  because  they  are  drunk.  I  should  like  to  see  this  barbar- 
ous squeamishness  pass  away,  and  to  see  society  protected  by  add- 
ing some  deterrent  degradation  to  crime  committed  during  in- 
toxication. I  should  like,  for  instance,  to  see  the  brute  who  kicks 
his  wife  and  children  when  in  liquor,  well  flogged,  in  addition  to 
the  penalty  for  assault.  And  drunken  exposure  of  the  person, 
and  insults  to  young  girls,  might  fairly  be  treated  with  the  same 
indignity.  The  less  innate  turpitude  there  is  in  a  criminal,  the 
more  possible  it  is  to  deter  and  reform  him.  Severity  is  worth 
practicing  when  there  is  a  chance  of  its  being  successful ;  just  as 

1  Dante's  angelic  guide  is  described  as  quoting  Aristotle  with  approval  : 

Non  ti  rimembra  di  quelle  parole, 
Con  le  quai  la  tua  Etica  pertratta 
Le  tre  disposizion,  che'l  Ciel  non  vuole; 

Incontinenza,  malizia  e  la  niatta 
Bestialitade?  o  come  incontinenza 
Men  Dio  offende,  e  men  biasimo  accatta? 

Inferno,  xi,  79. 

^Reference  is  intended  to  the  seventh  book  of  the  Nicomachean  Ethics.  "  In- 
continenza "  is  a  translation  of  dxpaala,  and  does  not  mean  "  incontinence  "  or 
"  intemperance  "  in  their  modern  narrowed  senses,  but  includes  all  varieties 
of  the  recklessness  of  unclean  living. 


ALCOHOL.  225 

when  a  patient  has  a  good  constitution,  a  vigorous  treatment  of 
accidental  ailments  is  to  be  commended. 

i —  • 

To  sum  up  the  influence  of  alcohol  upon  a  healthy  man,  it  would 
seem  to  be  as  follows : 

(1.)  When  taken  in  moderate  quantities,  and  with  meals,  it 
often  somewhat  increases  the  appetite  and  the  digestive  powers. 
And  the  modus  operandi  by  which  it  effects  this  object,  is  by  curb- 
ing the  deleterious  consequence  of  excessive  energy  of  the  nervous 
system. 

(2.)  When  taken  in  excess  its  first  noxious  influence  is  on  the 
nervous  system,  and  hence  we  find  in  predisposed  women  "  hys- 
teria," and  in  men  "  alcoholism  "  or  "  chronic  delirium  tremens." 

(3.)  When  taken  in  excess  it  so  far  impedes  the  renewal  of  the 
nerve  tissue,  that  the  vital  activity  of  the  bloodvessels  is  dimin- 
ished over-much  and  over-long. 

(4.)  Of  this  diminution  of  the  circulation,  one  result  is  local 
congestion  of  various  parts,  temporary  at  first  and  quite  capable 
of  relief,  but  by  long  continuance  tending  to  produce  permanent 
lesions. 

(5.)  If  too  long  deprived  of  the  nervous  energy  which  presides 
over  interstitial  growth,  the  parts  fall  into  atrophic  degeneration  ; 
and  instead  of  elastic,  fibrous,  areolar,  muscular  tissue,  and  what- 
ever else  of  subtle  structure  may  be  needful  to  animal  life,  there 
is  deposited  only  a  mass  of  friable,  lifeless  substances,  midway  in 
chemical  composition  between  albumen  and  fat. 

(6.)  It  is  probable  that  these  noxious  influences  are  continued 
so  long  as  the  alcohol  is  retained  in  the  blood. 

(7.)  The  principal  lesions  induced  by  steady  regular  excess  .of 
alcohol  are  cirrhosis  of  the  liver,  Bright's  disease,  condensation  of 
the  lungs,  thickening  of  the  larynx  and  bronchi,  ossification  and 
thickening  of  the  arteries.  And  it  is  difficult  to  say  what  secon- 
dary lesions  may  not  follow  upon  these. 

(8.)  The  increased  risk  to  life  from  injury  or  acute  disease,  in- 
curred by  the  intemperate,  may  be  accounted  for,  by  some  amount 
of  the  afore-mentioned  atrophy  having  already  taken  place  in 
their  bodies,  and  so  diminishing  their  force  of  recovery. 

(9.)  For  there  appears  to  be  a  likelihood  that  the  immediate 
anesthetic  power  of  alcohol  will  tend  to  spare  the  nerves  the  shock 

15 


226  SPECIAL    DIETETICS    OF    HEALTH. 

of  the  external  causes  of  disease,  and  so  render  it  less  injurious  to 
a  previously  sound  man. 

(10.)  Alcohol  cannot  be  trusted  to  prevent  tuberculosis,  though 
it  retards  its  progress. 

(11.)  Taken  in  still  greater  excess  at  once,  in  fact  so  as  to  pro- 
duce drunkenness,  it  is  probably  not  nearly  so  fatal  in  its  conse- 
quences. The  poisonous  drugging  of  the  nervous  system  is  fol- 
lowed by  an  attack  of  indigestion  and  general  pain,  during  which 
the  J?lood  purges  itself  of  the  alcohol. 

(12.)  Even  should  the  blows  to  the  nerves  inflicted  by  drunken 
bouts  be  continually  repeated,  the  consequences  follow  in  crises, 
and  may  be  recovered  from,  which  cannot  be  said  of  atrophic 
lesions.  These  crises  usually  consist  of  the  well-known  phenomena 
of  delirium  tremens,  which  often  so  alarm  the  patient  as  to  lead  to 
a  reform. 

(13.)  Some  forms  of  alcoholic  drinks  are  much  more  deleterious 
than  others,  especially  those  which  contain  a  large  proportion  of 
fusel  oil. 

Hence  we  may  deduce  these  rules  for  the  use  of  alcohol  by 
healthy  persons. 

(A.)  Let  it  be  taken  never  as  a  stimulant  or  preparative  for 
work,  but  as  a  defence  against  the  injury  done  by  work,  whether 
of  mind  or  body.  For  example,  it  is  best  taken  with  the  evening 
meal,  or  after  toil. 

(B.)  Let  the  increase  in  the  desire  for  and  power  of  digesting 
food  be  the  guide  and  limit  to  the  consumption  of  all  alcoholic 
liquids. 

(C.)  Let  the  forms  be  such  as  contain  the  least  proportion  of 
fusel  oil, 

(D.)  Let  all  with  an  hereditary  tendency  to  hysteria  or  other 
functional  disease  of  the  nervous  system,  refrain  from  its  use  alto- 
gether, even  though  as  yet  they  are  in  good  health.  Among  the 
hereditary  tendencies  must  be  classed  a  proclivity  to  delight  in 
drunkenness,  which  remarkably  runs  in  families.  Children  with 
such  an  heirloom  had  best  be  kept  as  late  as  possible  without  tast- 
ing strong  drink. 

The  legislative  authorities  have  the  opportunity  of  materially 
advancing  the  good  of  their  country  : 

(a.)  By  cheapening  through  fiscal  regulations  all  wholesome 


ALCOHOL.  227 

fermented  drinks,  such  as  good  beer  and  wine,  and  by  laying  the 
burden  of  taxation  on  the  retail  trade  in  spirits.1 

(6.)  By  declaring  fusel  oil  to  be  a  poisonous  adulteration  of  al- 
coholic beverages,  so  that  the  mother  of  invention  may  teach  dis- 
tillers to  eradicate  it. 

(c.)  By  severely  punishing  intoxication. 

(d.)  Habitual  intoxication  might  justly  be  made  aground  for 
the  dissolution  of  marriage,  in  that  a  wrong  is  done  to  the  nation, 
as  well  as  to  the  innocent  partner,  when  it  is  burdened  with  mem- 
bers incapable  of  contributing  to  the  common  weal,  which  is  so 
likely  to  be  the  case  with  the  progeny  of  drunkards.  When  the 
wrong  is  involuntary,  we  pardon  it ;  but  alcoholism  cannot  plead 
that  excuse,  unless  it  take  its  stand  on  the  ground  of  insanity, 
which  removes  the  question  into  another  category  altogether. 
Those  who  claim  the  rights  of  free  agents  must  answer  for  all  the 
consequences  of  their  acts. 

Were  the  law  to  express  such  a  marked  disapproval  of  drunken 
husbands  and  wives,  the  benefit  would  extend  much  wider  than 
the  few  whom  it  might  free  from  the  chain  of  matrimony ;  for  it 
would  teach  men  and  women  what  a  grave  offence  is  committed 
by  risking  the  parentage  of  an  idiot,  and  lead  them  to  take  means 
to  avoid  it. 

Nevertheless  the  most  powerful  engine  for  securing  to  mankind 
the  beneficial  influences  of  alcohol  without  its  attendant  dangers, 

1  Encouragement  may  be  taken  from  what  has  happened  in  California. 
Mr.  James  Morrison  writes: 

"  Before  the  introduction  of  native  wines,  when  the  stronger  alcoholic 
stimulants  were  used,  drunkenness  was  very  common  in  California.  The 
native  wines  are  now  found  in  nearly  every  houshold  ;  they  have  supplanted 
to  a  great  extent  the  use  of  the  stronger  alcoholic  drinks.  It  is  a  fact,  which 
no  one  familiar  with  California  for  the  last  twenty  years  will  deny,  that  drunk- 
enness is  much  less  common  now  than  formerly.  This  change  is  undoubtedly 
due  to  the  substitution  of  the  wine  of  the  country  for  the  stronger  alcoholic 
stimulants."  The  very  decided  effect  which  financial  legislation  can  have 
upon  the  comparative  consumption  of  different  sorts  of  liquors  is  shown  by 
the  effect  of  the  budget  of  April  6,  1872,  which  laid  a  heavy  tax  upon  ab- 
sinthe in  France.  Within  a  year  from  that  date  M.  Bergeron  was  able  to 
report  to  the  temperance  society  that  the  consumption  of  the  said  liqueur  had 
diminished  by  nearly  one-half.  See  Kevue  des  Deux  Mondes,  March  15, 
1874,  p.  476. 


228  SPECIAL    DIETETICS    OP    HEALTH. 

is  to  be  sought  in  the  habits  and  silent  pressure  of  social  life.  As 
our  race  becomes  more  humanized  by  training  and  experience,  it 
is  more  to  be  trusted  to  make  use  of  Heaven's  gifts  without  abus- 
ing them ;  and  the  degradation  of  mind  and  body  which  alcohol 
is  capable  of  entailing  will  become  hateful  at  the  same  pace  as  its 
true  value  becomes  understood.  Such  a  progress  is  worth  a 
hundredfold  all  possible  legislation.  The  man  who  prefers  law 
to  custom  announces  a  principle  which  would  set  the  means  above 
the  end,  would  stereotype  imperfect  efforts,  and  substitute  cork 
jackets  for  the  power  of  swimming.  Towards  the  progress  of 
temperate  habits  every  man  can  contribute — and  who  more  power- 
fully than  the  medical  man  ? — by  the  example  of  the  moderate 
use  of  fermented  beverages  of  the  right  sort  at  proper  times,  and 
by  the  discouragement  of  indulgence  and  excess.  There  is  a  dif- 
ficulty in  sending  a  drunkard  to  an  asylum,  but  he  is  easily  sent 
"  to  Coventry,"  and  made  to  feel  that  he  is  a  degraded  animal. 
There  may  possiply  be  some  rare  cases  to  be  found  of  true  "  dip- 
somania ;"  where,  without  any  other  mental  disease,  the  patients 
are  carried  off  by  an  uncontrollable  impulse  to  drink ;  but  they 
certainly  are  very  rare  indeed,  and  every  alleged  instance  that  I 
have  investigated  has  always  exhibited  also  some  other  form  of 
insanity,  sufficient  to  justify  the  imposition  of  restraint,  or  else 
proved  to  be  using  the  cant  of  the  day  as  an  excuse  for  self-indul- 
gence. The  exceptional  cases  may  be  separately  dealt  with,  when 
they  occur ;  but  as  a  rule  I  think  it  is  better  to  give  men  the  edu- 
cation of  being  their  own  gaolers  than  to  let  them  lean  on  the 
weak  crutch  of  state  inebriate  asylums. 

Voluntary  association  for  the  purpose  of  mutual  encouragement 
in  temperance,  for  the  discouragement  of  drunkenness  and  of  the 
use  of  ardent  spirits,  or  for  the  prosecution  of  the  sellers  of  adul- 
terated beverages,  stands  on  a  different  footing  from  legislative 
control.  It  is  a  step  in  self-education.  But  unhappily  it  has 
been  stopped  from  useful  employment  by  the  fatal  snare  of  exag- 
geration. The  denouncement  of  alcohol  as  always  a  poison,  and 
its  use  for  good  fellowship  as  a  sin,  is  now  inseparably  united  in 
our  minds  with  societies  for  the  promotion  of  true  temperance ; 
and  thus  the  latter  virtue  has  been  retarded  by  the  fatal  prejudice 
of  being  tied  up  in  the  same  bundle  with  a  fallacy.  The  society 
formed  in  France  about  two  years  ago,  under  the  title  "  L'Asso- 


ALCOHOL.  229 

ciation  frangaise  contre  Vabus  des  bolssons  alcooliques"  though  it 
may  not  make  such  a  noise  as  our  teetotalism,  has  a  better  basis 
of  action.  The  proposed  object  is  to  encourage  the  substitution 
of  inoifensive  and  salutary  drinks  for  spirits.  It  accepts  and 
recommends  the  use  of  beer,  of  natural  wine,  as  well  as  of  tea 
and  coffee  at  meals,  after  the  day's  work  is  done,  but  sets  its  face 
sturdily  against  distilled  liquors,  facilities  for  liquoring  between 
meals,  and  all  excess.  For  my  part  J.  have  faith  in  the  continu- 
ous improvement  in  the  human  race;  and  I  think  I  can  see,  not 
so  very  far  ahead  in  the  future,  the  influence  of  alcohol  upon 
health  perfected  in  its  good,  and  deprived  of  its  evil,  without  the 
dubious  aid  of  any  prohibitive  legislation. 

Some  well-meaning  persons  think  to  discourage  intemperance 
in  drink  by  affecting  a  cynical  carelessness  as  to  the  quality  of 
that  which  is  consumed.  They  allow  their  guests  "  a  little  wine 
for  their  stomachs'  sake,"  but  serve  it  out  as  like  a  drug  as  pos- 
sible. 

It  is  nothing  to  them  if  it  be  adulterated  or  not — "  wipe  away 
all  poetry,  all  refinement  from  the  cup,"  say  they,  "  and  it  will 
cease  to  tempt."  This  reasoning  is  utterly  false.  As  long  as  a 
sensual  pleasure  is  coarse  and  rude,  it  can  be  attractive  only  by 
its  quantity,  and  all  indulgence  can  be  only  excess.  But  let  it 
dress  itself  in  the  charms  of  a  higher  sestheticism,  let  the  enjoy- 
ment of  it  be  shared  with  others,  and  be  associated  with  noble 
and  beautiful  memories,  and  moderation  becomes  a  law  of  its  ex- 
istence. The  sensuality  of  the  savage  is  selfish,  shameless,  and 
unbridled.  With  the  advance  of  manners  it  first  parts  with  its 
selfishness,  then  it  acknowledges  the  evils  of  excess,  and  then 
curbs  itself  more  and  more  till  it  ceases  to  be  intemperance  at  all. 
True  of  other  gratifications  of  instinctive  desire,  this  is  especially 
true  of  drinking.  The  better  the  wine  is,  and  the  more  attractive 
its  aspect,  the  less  likely  are  people  to  take  too  much  of  it.  When 
Anacreon  and  Horace,  Phidias  and  Cellini,  Etruscan  potters  and 
Venetian  glass-blowers,  conspired  to  wreath  the  goblet  with  a 
halo  of  romance,  they  substituted  an  elegant  appreciation  for  a 
degrading  animalism,  and  led  society  a  step  onwards  in  morality. 
And  it  may  be  noticed  that  our  Divine  Exemplar  first  manifested 
forth  his  glory  by  giving  to  his  village  neighbors  not  only  wine, 


230  SPECIAL    DIETETICS    OF    HEALTH. 

but  a  pleasanter  wine  than  they  were  accustomed  to.  I,  therefore, 
hold  it  to  be  a  duty  of  every  one  to  see  that  whatever  sort  of  bev- 
erage is  provided  for  his  household  should  be  the  best  of  its  sort, 
the  most  agreeable  to  the  educated  palate,  and  adorned  with  the 
most  refined  surroundings  that  circumstances  allow.  However 
little  a  man's  purse  allows  him  to  drink,  let  it  be  good. 


DIETETICS  IN  SICKNESS, 


CHAPTER  L 

THE   DIET   AND    REGIMEN   OF   ACUTE   FEVERS. 

THE  principal  acute  fevers  enumerated  in  the  Nomenclature 
are  small-pox,  chicken-pox,  measles,  scarlatina,  typhus,  enteric 
(or  gastric),  relapsing,  yellow,  remittent,  cholera,  mumps,  influenza, 
weed.  Some  varieties  of  these,  characterized,  some  by  more  se- 
vere, and  some  by  milder  phenomena  than  ordinary,  receive 
special  names,  which  would  needlessly  lengthen  a  list  cited  simply 
for  the  purpose  of  explanation. 

One  of  the  most  natural  and  practical  divisions  of  diseases  is 
into  acute  and  chronic.  We  are  not  always  quite  sure  in  which 
class  to  place  the  special  morbid  process  we  happen  to  be  consid- 
ering; but  in  an  overwhelming  majority  of  instances  there  is  no 
doubt  at  all ;  and  when  we  have  decided,  the  light  thrown  on  the 
path  to  judicious  treatment  is  clear  and  bright.  By  "acute"  dis- 
ease is  meant  such  as  has  a  tendency  to  progress  in  a  circle  to- 
wards the  recovery  of  health :  each  process,  however  dangerous 
and  abnormal  it  may  be,  being  a  step  towards  the  final  arrival  at 
that  result,  if  only  the  sick  man's  strength  hold  out.  While  of 
"  chronic"  the  natural  road  is  straight  on  from  bad  to  worse,  un- 
less from  the  interposition  of  some  extraneous  agency  of  accidental 
or  designed  origin  foreign  to  the  process  of  the  disease  itself.  Dr. 
Pierre  Petit,  in  the  preface  to  his  "Commentary  on  Aretseus," 
compares  the  former  to  race-horses,  which  run  round  to  the  goal, 
unless  they  founder  on  the  way :  one  might  in  the  same  strain 
liken  the  path  of  the  latter  to  that  fatal  descent  which  leads  to 
Avernus.  This  division  of  maladies  is  of  the  most  essential  im- 


232  DIETETICS    IN    SICKNESS. 

portance  when  we  undertake  to  estimate  the  value  of  remedial 
measures.  Nearly  all  the  fallacies  which  have  overladen  our 
druggists'  shops,  not  to  speak  of  a  variety  of  theories  ending  in 
"pathy,"  which  crop  up  from  time  to  time,  flow  from  watching 
the  acute  phenomena  in  disease,  as  an  index  of  the  eifect  of  a 
•  medicine.  A  very  moderate  spice  of  medical  logic  will  suffice  to 
show  that  it  is  only  from  the  numerical  comparison  of  many 
public  institutions  for  many  years  that  an  opinion  can  be  formed 
in  acute  disease  concerning  that  eifect.  Whereas  by  observing  its 
action  in  chronic  disease,  one  cautious  man  may,  from  a  very 
small  number  of  well-considered  cases,  come  to  a  reasonable  con- 
clusion as  to  the  value  of  any  really  active  medication.  I  am 
used,  therefore,  in  instructing  pupils,  to  insist  very  much  on  the 
differences  between  acuteness  and  chronicity :  I  believe  the  idea  to 
be  of  great  importance  in  the  formation  of  the  medical  mind. 
And  in  the  limited  department  of  therapeutics  treated  of  in  this 
volume  it  must  not  be  passed  over,  for  in  the  most  chronic  cases 
there  are  acute  phenomena,  and  in  acute  cases  there  are  sometimes 
elements  of  chronicity  which  require  a  just  estimate  to  be  formed 
of  them,  when  we  come  to  test  the  efficacy  of  our  efforts  at  relief. 
In  acute  fevers,  it  is  evident  that  it  is  not  our  business  to  try 
and  arrest  the  symptoms,  any  more  than  it  is  our  business  to  arrest 
the  rising  tides.  We  must  only  take  care  that  they  do  not  swamp 
our  boat,  and  the  safest  way  to  do  that  is  to  keep  the  vessel  as 
sound  as  possible  and  as  capable  of  resisting  external  agencies  as 
we  can  make  it.  The  value  of  nutrition  in  fevers  has  been  ob- 
served from,  the  earliest  times :  Hippocrates  thought  so  much  of 
it  that  the  point  of  his  treatise  "  On  the  management  of  acute 

diseases  "  lies  in  his  recommendation  of  the  use  of  wine,  and  of  a 

_ 

ptisan  of  barley,  which  we  now  call  "gruel."  The  proper  prepa- 
ration of  the  latter  he  considers  so  important,  that  he  condescends 
to  tell  us  how  to  make  it,  so  that  it  may  be  "  thin,  but  not  too 
thin  ;  thick,  but  not  too  thick,"  as  Miss  Austen  describes  the  per- 
fection of  this  dietetic  article.  But  during  the  dark  ages  of  medi- 
cal science  a  bugbear  called  Inflammation  was  set  up,  and  acute 
disease  grew  to  be  considered  a  devouring  flame,  which  must  be 
starved  out  by  removing  fuel.  This  scare  culminated  in  the 
French  physicians  of  the  last  generation,  who  actually  deprived 
the  sick  of  all  food  whatsoever,  as  a  mode  of  treatment,  and  called 


ACUTE    FEVERS.  233 

it  diete.  That  was  going  too  far,  and  the  results  terrified  the 
neighboring  islanders,  who  in  the  person  of  Dr.  Graves  found  a 
voice,  and  maintained,  not  only  in  deeds  but  in  words,  that  the 
"  feeding  of  fevers"  was  the  most  essential  feature  in  their  cure. 
In  following  his  master,  Dr.  Graves  goes  a  step  beyond  the  cau- 
tious Hippocrates ;  for  though  he  sticks  to  gruel,  barley  water, 
and  whey,  the  first  three  or  four  days,  he  quickly  after  that  pro- 
ceeds to  chicken  broth,  meat  jelly,  and  strong  soup.  It  would  be 
a  platitude  to  point  out  the  difference  in  the  mortality  since  this 
change  of  practice.  Everybody  acknowledges  its  wisdom,  except 
a  very  few  eccentrics. 

The  great  art  of  duly  nourishing  fever  patients  consists  in  giv- 
ing a  frequent,  almost  continuous,  supply  of  liquid  nutriment  con- 
taining very  soluble  aliments  in  a  dilute  form.  Perhaps  I  may 
be  allowed  to  quote  myself  on  this  subject,  and  reproduce  a  clini- 
cal lecture  I  delivered  at  St.  Mary's  Hospital  thirteen  years  ago. 

"  The  physician  sees  that  a  large  supply  of  nitrogenous  material 
must  be  wanting.  The  nitrogenous  tissues  are  devitalized,  are 
drained  away  in  a  disproportionate  excretion  of  urea  and  other 
organic  compounds,  and  nothing  is  taking  their  place.  Shall  he 
act  antagonistically,  and  try  to  stop  the  passage  of  urea  by  the 
kidneys  ?  I  do  not  know  exactly  how  he  would  set  about  it ;  but 
I  do  know  that  if  he  succeeded,  he  would  do  positive  harm  •  for 
the  very  worst  cases  of  fever  are  those  in  which  metamorphosis  is 
active  (as  shown  by  the  heat),  while  the  excretion  of  urea  is  arrest- 
ed (as  shown  by  the  lightness  of  the  urine) ;  they  resemble  cases 
of  anemic  poisoning  from  diseased  kidneys.  The  other  principles 
of  treatment  which  I  noticed  in  my  introductory  lecture  would 
not,  perhaps,  be  so  directly  injurious,  but  common  sense  would 
still  allot  the  palm  to  restoration  here.  Let  it  be  your  chief  aim 
to  supply  that  which  you  clearly  see  is  passing  away — nitrogen- 
ous tissue. 

"But  how  will  you  supply  it?  Solid  food  would  in  all  prob- 
ability be  vomited,  from  the  unbearable  loathing  it  excites.  If 
not  vomited,  it  would  lie  for  some  time  a  mere  foreign  body  out- 
side the  mucous  membrane  of  the  digestive  canal,  and  then  pass 
away  by  diarrhoea,  with  much  flatus  and  fetor,  and  much  disen- 
gagement of  gas  during  putrefaction.  Your  beefsteak  might  as 
well  have  been  at  once  thrown  down  its  final  destination,  the 


234  DIETETICS    IN    SICKNESS. 

water-closet,  to  which  it  passes  putrid,  though  undigested.  Neither 
is  it  wise  to  fill  the  stomach  with  large  quantities  of  victuals,  for 
the  same  result  follows.  No  '  meals,'  therefore,  must  be  allowed; 
and  prudence  suggests  the  giving  in  their  place  very  small  doses 
of  nitrogenous  aliment  very  frequently.  These  pass  over  the  irri- 
tated stomach  unconsciously,  and  are  taken  up  gradually  by  the 
intestines,  requiring  but  very  little  to  make  them  fit  for  absorp- 
tion. The  suitablest  food  is  that  which  is  naturally  supplied  to 
the  weakest  "stomach.  The  feeble  digestive  organs  of  babies  can 
assimilate  milk,  and  milk  forms  the  most  appropriate  nourishment 
for  the  debilitated  viscera  of  the  fever  patient.  By  giving  two 
or  three  ounces  every  hour,  you  may  get  down  a  quart  and  a  half 
per  diem.  But  under  ordinary  circumstances  every  two  hours  is 
often  enough.  If  there  is  sufficient  acid  left  in  the  stomach  to  co- 
agulate the  casein  into  clots,  and  cheesy  lumps  are  rejected  by 
vomiting,  as  happens  sometimes  in  milder  cases,  you  may  guard 
against  this  by  adding  liquor  calcis  or  soda-water  to  the  milk,  or 
you  may  supply  its  place  by  beef  tea.  But  it  is  the  lumping  of 
the  cheese  into  solid  masses  that  it  is  desirable  to  avoid,  not  the 
acidification,  which  is  beneficial.  If  the  patient  takes  thus  a  good 
supply  of  milk  and  beef  tea,  not  only  is  the  imminent  danger  of 
death  by  starvation  avoided,  but  the  emaciation  which  follows 
during  convalescence  is  much  less  extreme,  and  the  dangers  in  its 
wake  less  formidable. 

"Eggs  are  a  highly  nutritious  food;  if  taken  raw,  and  diluted 
with  milk  or  water,  they  are  quickly  absorbed.  But  should  they 
be  delayed  and  putrefy,  the  products  of  their  decomposition  are 
peculiarly  injurious:  the  sulphuretted  hydrogen  and  ammonia 
evolved  are  poisons  to  the  intestines.  I  should  recommend  you 
to  avoid  eggs  till  convalescence  has  restored  the  gastric  powers. 
The  same  objection  does  not  lie  against  milk,  the  lactic  acid  aris- 
ing from  whose  decomposition  assists  in  the  solution  of  the  casein. 
Sour  buttermilk  is  by  no  means  to  be  despised  as  a  food."1 

When  a  patient  cannot  be  raised  in  bed  without  risk  of  exhaus- 
tion, a  crockery  or  glass  feeder  is  a  convenience,  but  the  same  ves- 
sel, or  even  one  of  the  same  appearance,  should  not  be  used  for 
food  and  for  medicine. 

1  Lectures  Chiefly  Clinical,  London,  1864,  lect.  vi  of  4th  ed. 


ACUTE    FEVERS.  235 

If  the  patient's  mouth  be  foul,  as  in  small-pox  or  putrid  fever, 
it  should  be  cleansed  when  he  is  fed.  The  administration  of  nutri- 
ment should  then  be  so  frequent  that  it  is  not  allowed  to  become 
again  foul.  In  fact  the  cleaner  it  is  kept  in  the  intervals,  the 
better. 

Food  taken  by  the  mouth  should,  as  a  rule,  be  as  near  the 
natural  temperature  of  the  body  as  possible.  But  when  the  febrile 
heat  is  very  high,  or  there  is  much  nausea,  some  of  it  may  be  iced 
with  advantage. 

When  the  stomach  is  inflamed,  as  we  are  taught  by  morbid 
anatomy  to  know  it  is  in  severe  scarlatina,  or  when  there  is  vomit- 
ing, only  a  few  teaspoonfuls  should  be  drunk  at  once  and  every- 
thing cold  and  dilute.  The  admixture  of  pepsin,  in  quantity 
not  exceeding  20  grains  a  day,  is  also  beneficial  to  these  patients. 
If  it  purges,  it  may  be  guarded  with  a  few  drops  of  laudanum. 

In  obstinate  vomiting  and  other  instances  where  the  ordinary 
paths  of  absorption  refuse  to  fulfil  their  functions,  it  is  necessary 
to  get  nutriment  taken  in  by  unusual  routes.  This  is  often  the 
case  at  the  height  or  later  end  of  acute  fevers,  and  then  life  may 
be  sustained  a  long  time  by  nutritive  injections  into  the  lower  end 
of  the  bowel.  Physiological  experiments  undertaken  with  the 
view  of  testing  the  power  of  absorption  in  these  parts  have  demon- 
strated that  many  soluble  drugs  may  be  introduced  into  the  blood 
through  their  mucous  membranes.  Opium,  for  instance,  acts 
quickly  when  so  given.  And  if  drugs,  why  not  aliment?  Food 
thus  administered  in  enema  must  be  dilute,  and  it  must  be  warm, 
and  then  very  likely  the  still  secreted  intestinal  juices  which  de- 
scend from  above  may  dissolve  a  considerable  amount  of  its  starch 
and  animal  fibre.  Yet  a  surer  way  of  securing  the  solution  is  to 
add  a  small  quantity  of  pepsin  to  take  the  place  of  gastric  juice, 
and  also  of  diastase  (in  the  shape  of  malt)  to  supply  the  deficiency 
of  saliva. 

When  life  seems  passing  away  under  their  eyes,  the  friends  will 
often  shrink  from  tormenting  (as  it  seems  to  them)  the  sick  man 
with  food.  Let  them  not  despair :  many  a  one  has  recovered 
after  the  doctor  has  taken  his  leave  with  a  sad  shake  of  the  head, 
and  without  making  a  fresh  appointment.  And  let  them  also  be 
stimulated  by  this  fact — namely,  that  the  pains  of  death  are  aggra- 
vated, if  not  mainly  caused,  by  the  failure  of  nutrition.  Even 


236  DIETETICS    IN    SICKNESS. 

when  apparently  insensible,  the  dying  suffer  much  increased  dis- 
tress from  want  of  food,  though  they  cannot  express  their  suffer- 
ings. 

The  use  of  alcohol  in  fevers  is  regulated  by  the  condition  of  the 
nervous  system.  If  there  is  great  prostration  of  strength,  or 
tremulousness  of  the  hands,  or  quivering  in  the  voice  and  respi- 
ration, if  there  is  delirium  of  a  low  muttering  character  when  the 
patient  is  left  quiet,  then  it  is  required.  Or  if  the  patient  is  ha- 
bituated to  a  full  allowance,  it  is  well  to  continue  to  give  a  little. 
A  sharp,  weak,  unequal  beat  of  the  heart  is  a  warning  that  some 
of  these  symptoms  are  likely  soon  to  come  on.  All  these  indicate 
that  the  nervous  system  is  feeling  very  sensitively  the  destructive 
metamophosis  going  on,  and  has  its  power  lowered  by  its  sensi- 
tiveness. Then  is  the  opportunity  for  the  strong  anaesthetic  we 
are  speaking  of,  which  I  order  without  scruple,  though  I  do  not 
view  it,  like  food,  as  part  of  the  necessary  cure  of  fever.  Above 
all,  the  friends  must  be  warned  not  to  employ  it  as  a  substitute 
for  food  :  it  may  be  useful  as  an  adjunct,  but  can  never  take  the 
place  of  true  restoratives. 

The  form  of  alcoholic  liquors  must  depend  a  good  deal  upon 
the  purses  of  those  who  pay  for  it.  Sound  port,  burgundy,  and 
champagne,  are  the  best,  but  I  do  not  despise  cheap  gin  if  I  can 
get  nothing  else. 

It  contributes  greatly  to  the  appetite  of  a  sick  person  if  the 
nurse  is  of  fresh,  clean, 'and  cheerful  aspect.  Her  dress  should  be 
of  some  washing  material  which  does  not  rustle,  of  a  soft  warm 
color,  and  not  stuck  out  with  crinoline  or  any  other  sort  of  "dress 
improver."  Black  is  always  nasty  to  the  sensitive  olfactory  nerves 
of  an  invalid.  Above  all,  she  must  have  a  quiet  decided  manner, 
and  never  fidget. 


COOKERY  FOR  FEVER  PATIENTS. 

White  Wine  Whey. 
(ALL  WHEYS  ARE  SUDORIFIC  AND  NUTRITIVE.) 

Put  two  pints  of  new  milk  in  a  saucepan  and  stir  it  over  a  clear 
fire  till  it  is  nearly  boiling;  then  add  a  gill  of  sherry,  and  simmer 


ACUTE    FEVERS.  237 

for  a  quarter  of  an  hour,  skimming  off  the  curd  as  it  rises.     Then 
add  a  tablespoonful  more  sherry  and  skim  again  for  a  few  minutes. 

Rennet  Whey. 

To  a  quart  of  new  milk,  either  warm  from  the  cow,  or  heated 
up  to  the  same  temperature,  add  a  large  tablespoonful  of  rennet.1 
Keep  up  the  heat  a  little  higher  till  the  curd  separates,  and  take 
it  off  with  a  spoon. 

Lemonade. 

Pare  a  lemon  very  thin  and  put  the  paring  in  a  jug  with  an 
ounce  of  sugar  candy.  Squeeze  the  lemon  into  it,  and  pour  on  a 
pint  of  boiling  water.  Orange  or  pineapple  may  be  used  instead 
of  lemon  as  a  variety. 

(Other  aqueous  drinks,  good  in  both  health  and  sickness,  have 
been  already  mentioned  at  the  end  of  Chapter  II,  §  10,  in  the 
First  Part,  p.  85.) 

Linseed  Tea  (Demulcent  and  Diuretic). 

Whole  linseed,  one  ounce; 
White  sugar,  one  ounce ; 
Liquorice  root,  half  an  ounce ; 
Lemon-juice,  four  tablespoonfuls. 

Pour  on  the  materials  two  pints  of  boiling  water,  let  them  stand 
in  a  hot  place  four  hours,  and  then  strain  off  the  liquor. 
Do  not  give  this  to  patients  taking  lead,  iron,  or  copper. 

Barley  Water. 

Wash  two  ounces  of  pearl  barley  with  cold  water.  Then  boil 
it  for  five  minutes  in  some  fresh  water,  and  throw  both  waters 
away.  Then  pour  on  two  quarts  of  boiling  water,  and  boil  it 
down  to  a  quart.  Flavor  with  thinly  cut  lemon  rind,  and  sugar 
to  taste,  but  do  not  strain  unless  at  the  patient's  special  request. 

Water  Gruel. 

Mix  one  large  tablespoonful  of  oatmeal  into  a  smooth  paste 
1  See  end  of  chap,  ii,  sec.  7,  in  first  part,  p.  67. 


238  DIETETICS    IN    SICKNESS. 

with  a  little  cold  water.  Pour  in,  mixing  all  the  time,  a  pint  of 
boiling  water.  Boil  for  ten  minutes,  stirring  as  before,  and  strain. 
It  may  be  eaten  with  salt  or  sugar,  according  to  taste. 

Another  Gruel. 

Grits  i  oz. ;  Water  f  pint;  Milk  J  pint;  Sugar  J  oz.  (Children's 
Hospital). 

Arrowroot. 

Mix  one  large  tablespoonful  of  arrowroot  into  a  smooth  thin 
paste  with  a  little  cold  water.  Pour  in  a  pint  of  boiling  water, 
and  flavor  as  required. 

For  "milk  gruel"  and  "milk  arrowroot"  milk  is  substituted 
for  water. 

Rice  Gruel  (somewhat  astringent,  in  cases  of  diarrhoea). 

Take  of 

Ground  rice,  two  ounces ; 
Cinnamon,  a  quarter  of  an  ounce; 
Water,  four  pints. 

Boil  for  forty  minutes;  then  add  a  tablespoonful  of  orange  mar- 
malade. 

Bael  Drink  (in  dysentery  and  diarrhoea}. 

The  liquid  extract  of  unripe  Bael  fruit  (Liquor  JSelce),  one  or 
two  tablespoonfnls  to  a  pint  of  water. 

Alum  Whey  (in  diarrhcea}. 

Use  alum  in  place  of  rennet  to  curdle  the  milk,  in  the  propor- 
tion of  about  a  quarter  of  an  ounce  to  the  first.  Otherwise  make 
it  as  rennet  whey. 

Almond  Drink  (softening  and  nutritive  in  chest  cases}. 

A  useful  and  pleasant  drink  may  be  quickly  prepared  by  rub- 
bing up  two  ounces  of  the  "  compound  powder  of  almonds  "  (to  be 
got  at  any  chemist's)  with  a  pint  of  water. 

Claret  Cup  for  Invalids. 
Haifa  bottle"  of  claret  to  a  bottle  of  soda-water.     Haifa  dozen 


ACUTE    FEVERS.  239 

drop?  of  sweet  spirits  of  nitre  (spiritus  cetheris  nitrosi]  put  into  the 
jug  first  gives  a  fruity  flavor. 

Egg  Nogg  of  the  British  Pharmacopoeia. 

Best  French  brandy,  four  ounces ; 
Cinnamon  water,  four  ounces ; 
Yolks  of  two  eggs ; 
Sugar,  half  an  ounce. 

Rub  the  sugar  and  egg  yolk  together,  then  add  the  rest. 

Cleansing  Wash  for  the  Mouth  before  Food. 
A  tablespoonful  of  Condy's  solution1  in  a  pint  of  tepid  water. 

Egg  Soup. 

Water,  one  pint ; 

The  yolks  of  two  eggs  ; 

Butter,  a  lump  as  large  as  a  big  walnut; 

Sugar,  according  to  taste. 

Beat  them  up  together  over  a  slow  fire,  gradually  adding  the 
water.  When  it  begins  to  boil,  pour  it  backwards  and  forwards 
between  the  saucepan  and  jug  till  quite  smooth  and  frothy. 

Panado. 

Bread-crumb,  one  ounce ; 
Mace,  one  blade; 
Water,  one  pint. 

Boil,  without  stirring,  till  they  mix  and  turn  smooth,  then  add 
a  grate  of  nutmeg,  a  small  piece  of  butter,  a  tablespoonful  of 
sherry,  and  sugar,  according  to  taste. 

,  Whok  Beef  Tea. 

Make  the  cook  understand  that  the  virtue  of  beef  tea  is  to  con- 
tain all  the  contents  and  flavors  of  lean  beef  in  a  liquid  form;  and 


1  Or  two  tablespoonfuls  of  the  "liquor  of  permanganate  of  potash  "  of  the 
British  Pharmacopoeia. 


24:0  DIETETICS    IN    SICKNESS. 

that  its  vices  are  to  be  sticky  and  strong,  and  to  set  in  a  hard 
jelly  when  cold. 

When  she  understands  this,  let  her  take  half  a  pound  of  fresh- 
killed  beef  for  every  pint  of  beef  tea  required,  and  remove  all  fat, 
sinew,  veins,  and  bone.  Let  it  be  cut  up  into  pieces  under  half 
an  inch  square,  and  soak  for  twelve  hours  in  one-third  of  the 
water.  Let  it  then  be  taken  out  and  simmered  for  two  hours  in 
the  remaining  two-thirds  of  the  water,  the  quantity  lost  by  evap- 
oration being  replaced  from  time  to  time.  The  boiling  liquor  is 
then  to  be  poured  on  the  cold  liquor  in  which  the  meat  was  soaked. 
The  solid  meat  is  to  be  dried,  pounded  in  a  mortar,  freed  from  all 
stringy  parts,  and  mixed  with  the  rest. 

When  the  beef  tea  is  made  daily,  it  is  convenient  to  use  one 
day's  boiled  meat  for  the  next  day's  tea,  as  thus  it  has  time  to  dry 
and  is  easier  pounded. 

A  wholesome  flavoring  for  beef  tea  is  fresh  tomato,  now  so  com- 
monly grown  on  a  south  wall  in  gardens.  A  piece  of  green  celery 
stalk,  or  a  small  onion,  and  a  few  cloves,  may  also  be  boiled  in  it. 
Leeks  give  it  a  fusty  flavor,  and  mushroom  ketchup,  which  some 
cooks  introduce,  is  of  doubtful  composition. 

While  this  is  a-cooking,  some  more  hastily  prepared  in  the 
usual  way  may  be  used,  or  even  Liebig's  Extract,  provided  care 
be  taken  that  the  latter  is  sufficiently  diluted,  so  as  not  to  turn 
the  stomach. 

Quicker  but  less  economical  Beef  Tea. 

One  pound  of  raw  beef,  minced,  for  each  pint  of  water.  Stir 
up  cold  and  let  it  stand  one  hour.  Then  place  the  vessel  in  which 
they  are  mixed  in  a  pan  of  water  and  heat  them  up  to  about  180° 
Fahr.  for  another  hour  over  a  slow  fire.  If  boiled  up  to  212°  it 
becomes  gluey,  and  is  not  equally  nutritious  or  digestible.  Run 
the  tea  through  a  coarse  strainer,  and  flavor  at  discretion. 

Beef  and  Hen  Broth  (Gouffe'). 

Still  quicker  and  still  less  economical  is  the  following : 
Take  1  Ib.  of  lean  beef; 
£  a  hen,  boned ; 

Pound  together  in  a  mortar;  add  ^  oz.  of  salt ;  put  in  a  stew- 


ACUTE    FEVERS.  241 

pan  with  2|  pints  of  water;  and  stir  over  the  fire  till  boiling; 
then  add  carrots,  onions,  leeks,  and  celery,  cut  fine ;  boil  for  half 
an  hour ;  strain,  and  serve. 

Beef  tea  and  broth  should  not  be  kept  hot,  but  heated  up  as 
required.  It  may  be  warmed,  but  never  prepared  in  the  sick- 
room, for  nothing  sets  an  invalid  against  food  so  much  as  cooking. 
If  a  nurse  can  rig  up  a  fire  or  a  gas  stove  for  her  own  use  in  an 
adjoining  room,  well  and  good ;  but  if  not,  she  had  better  descend 
to  the  kitchen.  In  summer,  when  a  fire  is  undesirable,  she  may 
employ  Silver's  patent  Norwegian  cooking  box,  in  which  cooking 
is  done  by  hot  water.  But  it  is  rather  an  expensive  mode  of  at- 
taining a  simple  object,  unless  the  nurse  were  to  keep  one  as  part 
of  her  stock  in  trade. 

Chicken  Broth. 

Skin,  and  chop  up  small,  a  small  chicken,  or  half  a  large  fowl, 
and  boil  it,  bones  and  all,1  with  a  blade  of  mace,  a  sprig  of  parsley, 
and  a  crust  of  bread,  in  a  quart  of  water  for  an  hour,  skimming 
it  from  time  to  time.  Strain  through  a  coarse  cullender. 

Chicken  broth  poured  on  sippets  laid  on  the  bottom  of  the  dish, 
makes  a  good  sauce  for  boiled  chicken  or  partridge,  when  the  in- 
valid is  well  enough  to  be  allowed  solid  food. 

Mutton  Broth. 

Lean  loin  of  mutton,  one  pound,  exclusive  of  bone ; 
Water,  three  pints. 

Boil  gently  till  very  tender,  throwing  in  a  little  salt  and  onion, 
according  to  taste.  Pour  out  the  broth  into  a  basin,  and  when  it 
is  col  1,  skim  off  all  the  fat.  It  can  be  warmed  up  as  wanted. 

If  barley  or  rice  is  added,  as  is  desirable  during  convalescence, 
it  must  be  boiled  first  separately,  till  quite  soft,  and  added  when 
the  broth  is  heated  for  use. 


1  Some  people  add  the  feet,  which  contribute  a  peculiarr  and  not  always 
acceptable  flavor. 

16 


242  DIETETICS    IN    SICKNESS. 

Ed  Broth. 

Skin,  clean,  and  chop  up  into  pieces  an  inch  long,  half  a  dozen 
small  eels.  Boil  them  in  a  pint  and  a  half  of  water,  skim,  and 
then  cover  over  and  stew  for  forty  minutes.  This  makes  a  capi- 
tal stock  for  a  souchee  of  flounders,  sole,  or  perch,  and  a  very  good 
change  for  convalescents  from  fevers.  The  object  is  to  avoid 
giving  butter  sauce,  which  is  apt  to  turn  rancid. 

Boiled  Pigeon  or  Partridge. 

Clean  and  season  the  bird,  inclose  it  in  a  puff  paste,  and  boil. 
Serve  in  its  own  gravy,  supplemented  by  the  liver  rubbed  up  with 
some  stock,  and  do  not  forget  the  bread  sauce. 

Bread  Sauce. 

The  crumb  of  a  French  roll ; 

Water,  half  a  pint ; 

Black  pepper,  six  to  eight  corns ; 

A  small  piece  of  onion  and  salt  to  taste. 

Boil  till  smooth ;  then  add  a  piece  of  butter  about  as  big  as  a 
walnut,  and  mix  for  use.  It  is  good  hot  with  hot  birds,  cold 
with  cold  birds,  and  is  an  excellent  food  for  the  sick. 

Nutrient  Enema. 
(In  cases  where  the  stomach  rejects  food.} 

Take  of  beef  tea  half  a  pint,  and  thicken  it  with  a  teaspoonful 
of  tapioca.  Reduce  If  oz.  of  raw  beef  to  a  fine  pulp,  pass  it 
through  a  fine  cullender,  and  mix  the  whole  up  with  20  grains  of 
acid  pepsin  (Boudault's  poudre  digestive]  and  4  grains  of  diastase 
(or  a  dessertspoonful  of  malt  flour)1  (Fonssagrives).2 

It  should  have  a  bright  rose  tint,  and  exhale  a  rich  meaty  odor. 
Not  more  than  a  quarter  of  a  pint  at  once  should  be  used,  and 
that  slowly.  Thus,  frequent  repetition  is  facilitated. 

1  Where  malt  flour  is  used,  the  tapioca  may  be  omitted. 

2  Journal  de  Med.  et  de  Chir.  Prat.,  1862. 


ACUTE    FEVERS.  243 

Pending  the  arrival  of  the  pepsin  and  malt,  the  other  portion 
of  the  liquid  may  be  administered  alone. 

Malt  Tea. 

(Nutrient  in  cases  where  the  mouth  is  very  dry.] 
Boil  three  ounces  of  malt  in  a  quart  of  water. 

Biscuit  and  Mill:. 

Soak  for  about  eight  hours,  till  it  is  quite  pultaceous,  a  hard 
captain's  biscuit  in  milk  or  in  water.  Pour  off  what  it  has  not 
absorbed,  and  mix  it  up  in  a  pint  of  new  milk. 

Bread  Pudding. 

Pour  over  a  French  roll  half  a  pint  of  boiling  milk,  cover  it 
close,  and  let  it  stand  till  it  has  soaked  up  the  milk.  Tie  it  up 
lightly  in  a  cloth,  and  let  it  boil  for  a  quarter  of  an  hour.  Turn 
it  out  on  a  plate,  and  sprinkle  a  little  sugar  candy  over  it.  The 
addition  of  burnt  sugar  or  tincture  of  saffron  will  give  it  the 
established  yellow  color. 

Rice  Pudding. 

Boil  two  ounces  of  rice  in  a  pint  of  milk,  assiduously  stirring 
till  it  thickens.  Take  it  off  and  let  it  cool.  Then  mix  in  well 
two  ounces  of  butter,  a  quarter  of  a  nutmeg  grated,  and  sugar  in 
moderation,  according  to  taste.  Pour  it  into  a  buttered  dish  and 
bake. 

Batter  Pudding. 

Flour,  three  teaspoonfuls ; 
Milk,  one  pint; 
Salt,  a  pinch ; 

Of  powdered  ginger,  nutmeg,  and  tincture  of  saffron,  each  a  tea- 
spoonful.  Boil. 

The  point  in  the  last  three  recipes  is  the  avoidance  of  eggs, 
which,  when  baked  or  even  when  boiled  so  long  as  it  is  necessary 


244  DIETETICS    IN    SICKNESS. 

to  boil  puddings,  are  quite  insoluble  in  a  weak  stomach.  If,  how- 
ever, they  are  dressed  separately,  and  either  kept  raw  or  lightly 
heated,  they  may  be  made  into  a  custardy  sauce,  which  is  quite  di- 
gestible in  small  quantities.  To  this  a  little  wine  may  be  added 
as  a  flavoring. 

The  Invalid's  Tea. 

Pour  into  a  small  china  or  earthenware  teapot  a  cup  of  quite 
boiling  water,  empty  it  out,  and  while  still  hot  and  steaming,  put 
it  in  the  tea.  Add  enough  boiling  water  to  wet  it  thoroughly, 
and  set  it  close  to  the  fire  to  steam  for  five  or  six  minutes.  Then 
pour  in  the  quantity  of  boiling  water  required,  from  the  kettle, 
and  it  is  ready  for  use. 

The  Invalids  Mashed  Potato. 

Boil  one  pound  of  potatoes  with  their  jackets  on  till  they  are 
tender  or  brittle.  Peel  them,  and  rub  them  through  a  fine  sieve; 
when  cool,  add  a  small  teacupful  of  fresh  cream  and  a  little  salt, 
beating  the  puree  up  lightly  as  you  go  on,  till  it  is  quite  smooth, 
and  warming  it  up  gently  for  use. 


INFLAMMATIONS.  245 


CHAPTEE  II. 

DIET  OF   CERTAIN   OTHER   INFLAMMATORY  STATES. 

INFLAMMATION  arising  from  the  congestion  of  any  part  of  the 
body,  whether  in  immediate  consequence  of  injury,  cold,  heat,  or 
other  external  accident,  or  from  some  previous  disease  or  lesion, 
gets  well  soonest  and  safest  when  the  blood  is  kept  in  as  normal 
a  condition  as  possible.  The  healthier  and  more  efficient  for  nu- 
trition the  blood  is,  the  more  freely  it  circulates,  the  less  are  the 
throbbing,  the  swelling,  the  heat,  the  formation  of  mucus,  pus, 
or  fibrin,  and  the  risk  of  ulceration  or  gangrene.  Bruises,  wounds, 
sores,  and  the  necessary  gaps  made  by  the  surgeon's  knife,  all  heal 
the  better  for  the  blood  being  kept  red  and  fluid. 

Now  starvation  has  precisely  the  opposite  effect :  it  augments 
the  proportion  naturally  borne  by  the  fibrin  to  the  red  blood- 
globules;  it  makes  the  circulating  fluid  more  readily  coagulate, 
more  adhesive,  and  consequently  more  prone  to  stick  to  the  sides 
of  the  minute  vessels  through  which  it  ought  to  flow,  and  more 
liable  to  block  them  up,  and  thus  to  favor  their  throbbing  and 
swelling,  and  sometimes  their  rupture.  Also,  by  letting  effete 
material  remain  to  form  the  bulk  of  the  blood,  it  renders  that 
fluid  unfit  to  supply  new  tissue,  and  pus,  mucus,  etc.,  are  supplied 
instead.  Pus  is,  in  fact,  imperfect  flesh  strangled  in  its  concep- 
tion, bioplasm  which  has  lost  its  plasticity. 

Our  object  then  should  be  to  keep  the  blood  in  the  highest 
health,  by  giving  it  all  the  nutriment  it  is  capable  of  duly  absorb- 
ing. The  arguments  used  regarding  general  fevers  apply  more 
forcibly  here,  in  that,  the  whole  body  not  being  so  universally 
smitten  with  disease,  the  stomach  (as  we  are  often  told  by  the  ap- 
petite) retains  much  of  its  assimilative  power,  and  is  more  likely 
to  make  a  good  use  of  what  is  given  it  than  in  the  former  case. 

When  the  desire  for  food  is  genuine  and  keen,  there  is  no  ob- 
jection to  the  continuance  of  the  ordinary  allowance  of  animal  and 


246  DIETETICS    IN    SICKNESS. 

vegetable  diet  at  the  usual  times.  But  care  must  be  taken  to  no- 
tice that  the  appetite  is  real,  and  not  a  wish  dependent  on  whim, 
habit,  or  the  aim  at  appearing  less  ill  than  people  suppose. 

The  above  rule,  however,  does  not  apply  to  stimulants.  Beer, 
wine,  or  spirits,  if  allowed  at  all  as  a  food  or  with  food,  must  be 
restricted  to  smaller  quantities  than  are  taken  in  health.  The 
patient's  nutrition  goes  on  better  without  them  altogether,  unless 
the  state  of  the  nervous  system,  as  in  fevers,  should  require  the 
adventitious  aid.  (See  last  chapter.) 

When  loss' of  appetite  indicates  that  the  powers  of  the  stomach 
are  in  partial  abeyance,  then  the  nutrient  administered  should  be 
liquid,  easily  convertible  into  chyle,  and  in  frequent  small  doses, 
for  the  reasons  before  detailed. 

After  surgical  operations,  and  in  many  other  cases  where  there 
is  a  tendency  to  a  copious  formation  of  pus,  health  is  promoted  by 
the  use  of  fresh  green  vegetables  and  of  lemonade,  and  of  digesti- 
ble fruits,  such  as  recently  gathered  grapes,  currants,  blackberries, 
barberries,  or  whortleberries.  Oranges  and  pomegranates  are 
cooling  to  the  mouth,  and  occupy  agreeably  many  a  dull  minute 
in  the  eating.  They  are  all  wrholesomer  before  food  than  after. 

Hitherto  common,  or  non-specific,  inflammation  has  been  spoken 
of.  When  the  inflammation  has  a  specific  character,  a  new  ele- 
ment is  introduced  into  the  treatment,  and  the  general  rules  above 
alluded  to  do  not  apply. 

In  ACUTE  RHEUMATIC  FEVER  experience  demonstrates  that  a 
nutrient  analeptic  diet  retards  recovery,  and  will  even  bring  on  a 
relapse  during  convalescence.  It  is  a  painful  thing  to  restrain  a 
patient  from  wholesome  food  when  he  craves  for  it,  but  in  this  in- 
stance it  is  our  duty.  If  meat  in  any  form,  solid  or  liquid,  be 
eaten,  it  seems  to  turn  into  lactic  acid,  which  many  think  is  al- 
ready in  excess  in  the  rheumatic  blood — at  all  events  it  adds  to 
the  quantity  of  organic  acids  in  the  body.  The  power  of  fully 
converting  it  into  living  flesh  is  wanting,  and  until  this  power  is 
regained,  a  semi-conversion  into  the  substance  named  takes  place. 
The  smell  of  sour  milk  in  the  skin  of  rheumatic  fever  patients  is 
well  known,  and  seems  to  support  the  theory  alluded  to.  Meat 
augments  it,  and  adds  also  to  the  acidity  of  the  urine.  The  redder 
and  more  muscular  the  meat  is,  the  more  it  disagrees. 

Vegetable  food  does  not  turn  so  copiously  or  so  quickly  acid ; 


INFLAMMATIONS.  247 

so  that  water  gruel  of  oatmeal,  grits  or  rice,  soup  meagre,  jellies, 
spiced  rice,  plain  boiled  rice,  panado  and  other  various  prepara- 
tions of  bread,  mashed  potatoes,  porridge,  arrowroot  and  semolina 
puddings,  Oswego  corn,  and  the  like,  must  be  used  to  satisfy  the 
mouths  which  often  loudly  complain  of  starvation.  The  cases 
which  prosper  are  those  where  the  appetite  is  keen,  but  has  been 
denied  any  food  beyond  what  is  absolutely  necessary  to  barely 
sustain  life.  The  aqueous  drinks  should  be  alkaline. 

Even  when  the  pains  are  gone  and  nature  calls  for  the  replace- 
ment of  the  lost  flesh,  the  diet  which  promises  most  readily  to 
replace  it  will  sometimes  bring  on  a  relapse,  and  you  must  very 
cautiously  go  back  to  "  ordinary  diet,"  else  you  run  a  risk  of 
eventually  losing  time  by  overmuch  haste. 

But  it  cannot  be  said  of  acute  rheumatism  as  of  other  cyclical 
fevers  that  the  diet  is  the  most  important  part  of  the  treatment. 
The  action  of  variations  of  temperature,  especially  in  the  direc- 
tion of  cold,  is  so  extremely  injurious  in  prolonging  the  disease, 
increasing  its  painfulness,  and  endangering  life  by  causing  peri- 
carditis, that  indubitably  a  more  paramount  value  attaches  to  a 
scrupulous  protection  of  the  body  against  such  changes.  Fresh- 
ness of  air,  so  valuable  in  typhus  and  its  allied  states,  is  in  this 
case  a  minor,  very  minor,  consideration  compared  with  its  steady 
warmth.  You  must  be  careful,  even  when  making  your  daily 
stethoscopic  examination,  not  to  expose  the  chest  to  chill.  A 
careless  and  dangerous  doctor  may  always  be  known  by  his  neglect 
of  precaution  in  these  cases.  Chilling  the  skin  of  a  rheumatic 
fever  patient  not  only  turns  the  rheumatic  inflammation  into  fib- 
rinous  inflammation  (as  in  pericarditis),  but  it  also  still  further 
deteriorates  the  process  of  nutrition.  After  a  chill  you  will  see 
the  urine  become  turbid  from  the  deposit  of  lithates,  the  effete 
products  of  a  deranged  assimilation.  Dieting  the  sick  is  useless 
unless  appropriate  means  are  adopted  for  securing  the  digestion  of 
the  diet.  And  tne  most  essential  means  in  rheumatic  fever  is  at- 
tention to  the  temperature.1 

In  GOUT,  during  the  acute  access,  the  same  restricted  diet  con- 
duces to  shortening  the  inflammation ;  but  it  is  not  so  imperative, 

1  I  have  enlarged  more  fully  on  this  important  subject  in  Lectures  Chiefly 
Clinical,  lectures  xi,  xii,  and  xiii,  4th  edition. 


248  DIETETICS    IN    SICKNESS. 

and  when  the  general  health  has  been  weakened  by  previous  at- 
tacks it  cannot  often  be  borne.  The  treatment  of  chronic  gout 
and  the  gouty  diathesis  requires  separate  consideration. 

Soup  Meagre. 

Take  of  butter  half  a  pound.  Put  it  in  a  deep  stew-pan,  place 
it  on  a  gentle  fire  till  it  melts,  shake  it  about,  and  let  it  stand  till 
it  has  done  making  a  noise;  have  ready  six  medium-sized  onions 
peeled  and  cut  small,  throw  them  in  and  shake  them  about.  Take 
a  bunch  of  celery,  cut  it  in  pieces  about  an  inch  long,  a  large 
handful  of  spinach  cut  small,  and  a  little  bundle  of  parsley 
chopped  fine ;  sprinkle  these  into  the  pan,  and  shake  them  about 
for  a  quarter  of  an  hour ;  then  sprinkle  in  a  little  flour  and  stir  it 
up.  Pour  into  the  pan  two  quarts  of  boiling  water,  and  add  a 
handful  of  dry  bread-crust  broken  in  pieces,  a  teaspoonful  of 
pepper,  and  three  blades  of  mace  beaten  fine  ;  boil  gently  another 
half  hour.  Then  beat  up  the  yolks  of  two  eggs  with  a  teaspoon- 
ful of  vinegar,  and  stir  them  in,  and  the  soup  is  ready. 

The  order  in  which  the  ingredients  are  added  is  very  important. 

Bread  Soup. 

Take  the  crust  of  a  stale  roll,  cut  it  in  pieces,  and  boil  it  well 
in  a  pint  of  water  with  a  piece  of  butter  as  big  as  a  walnut,  stir- 
ring and  beating  them  till  the  bread  is  mixed.  Season  with  celery 
and  salt. 

Alkaline  Drink. 

Cut  the  rind  of  a  lemon  very  thin,  and  put  it  in  a  jug  with  a 
tablespoonful  of  powdered  sugar-candy.  Pour  on  it  a  little  boil- 
ing water,  and  when  it  is  dissolved,  half  a  pint  of  Vichy  water, 
and  half  a  pint  of  common  water. 

The  White  Drink  (Decoction  Blanche}. 

Burnt  hartshorn,  powdered,  two  ounces ; 
Gum  arabic,  an  ounce  and  a  half; 
Water,  three  pints. 

Boil  down  to  a  pint,  strain,  and  add  sugar. 


INFLAMMATIONS.  249 

Isinglass  Jelly. 

Boil  an  ounce  of  isinglass  and  a  dozen  cloves  (if  liked)  in  a 
quart  of  water  down  to  a  pint.  Strain  hot  through  a  flannel  bag 
on  two  ounces  of  sugar-candy,  and  flavor  with  a  little  angelica 
root,  or  two  or  three  tablespoon  fuls  of  Liqueur  de  la  Grande 
Chartreuse,  if  cloves  are  not  relished. 

Hartshorn  Jelly. 

Boil  half  a  pound  of  hartshorn  shavings  (not  "raspings," 
which  are  adulterated  with  bone-dust)  or  an  equal  weight  of  ivory 
turnings,  in  three  pints  of  water  down  to  a  pint,  strain,  and  add 
three  ounces  of  white  sugar-candy,  and  an  ounce  of  lemon-juice. 
Heat  again  up  to  the  boiling-point.  As  a  variety  in  flavoring, 
white  Capri,  Moselle,  or  champagne  may  be  used  in  quantity  not 
exceeding  two  tablespoonfuls. 

The  gelatin  derived  from  these  sources  claims  no  advantages 
over  that  obtained,  as  directed  in  cookery  books,  from  calves'  feet. 
But  it  is  more  soluble  and  digestible  than  if  made  from  the  ordi- 
nary "gelatin"  of  the  shops,  which  is  manufactured  from  old 
bones,  probably  after  maceration  in  acid.  There  is  something 
gained  by  using  for  invalids  dishes  differing  in  name  and  sub- 
stance from  those  usually  set  before  the  robust,  as  it  is  thus  easier 
to  secure  their  being  made  properly,  and  not  according  to  the  tra- 
ditions of  the  kitchen.  A  cook  whose  "  calves'  feet  jelly  "  has 
been  commended,  will  demur  to  receive  a  recipe  for  its  ingredients 
from  the  doctor,  but  will  allow  him  to  be  in  his  legitimate  prov- 
ince when  he  orders  hartshorn  or  isinglass — they  are,  or  were 
lately,  in  the  Pharmacopoeia. 

Bread  Pudding  (with  egg). 

Take  of  crumbs  of  bread,  2  ounces ; 
New  milk,  ^  of  a  pint,  boiling  hot. 

Pour  the  hot  milk  on  the  bread,  and  let  it  stand  about  an  hour 
covered  up ;  then  add  the  yolk  of  an  egg,  well  beaten ;  then  a 
teaspoonful  of  rose  or  orange-flower  water,  a  little  nutmeg,  and 
half  an  ounce  of  sugar.  (Instead  of  sugar,  some  prefer  salt.) 


250  DIETETICS    IN    SICKNESS. 

Beat  all  up  together.     Tie  up  and  boil  or  steam  or  bake  three- 
quarters  of  an  hour. 

Bread  Pudding  (without  egg). 

Pour  half  a  pint  of  boiling  milk  over  a  French  roll,  and  let  it 
stand,  covered  up,  till  it  has  soaked  up  the  milk.  Tie  lightly  in 
a  cloth,  and  boil  twenty  minutes. 

'    Mutton  Broth. 

f  Ib.  of  neck  of  mutton,  free  from  fat,  1  oz.  of  carrots,  1  oz.  of 
turnips,  \  oz.  of  onions,  \  oz.  of  barley.  Boil  first  the  barley  in 
\  pint  of  water,  for  half  an  hour,  and  throw  that  water  away ; 
then  put  the  boiled  barley  and  the  meat  in  If  pint  of  water ;  boil 
and  skim  for  a  quarter  of  an  hour;  then  add  the  vegetables,  and 
boil  till  the  meat  .is  tender.  To  make  \\  pint  of  broth. 

Rose  Tea. 

Take  of  red  rose-buds  (the  white  heels  being  taken  off) 

half  an  ounce ; 

White  wine  vinegar,  three  tablespoonfuls  ; 
White  sugar-candy,  one  ounce. 

Put  them  in  two  pints  of  boiling  water,  and  let  them  stand  near 
a  fire  for  two  hours,  then  strain. 

Similar  acid  drinks  may  be  made  of  apple  jelly,  guava  jelly, 
damson  cheese,  or  syrup  of  gooseberries,  barberries,  etc.,  and  a 
variety  is  always  agreeable. 

Sage  Tea. 

Take  of  leaves  of  green  sage,  plucked  from  the  stalks  and 

washed  clean,  half  an  ounce; 
Sugar,  one  ounce; 
Outer  rind  of  lemon  peel,  finely  pared  from   the  white, 

quarter  of  an  ounce. 

Put  them  in  two  pints  of  boiling  water,  let  them  stand  near  the 
fire  half  an  hour,  then  strain. 

When  the  sage  is  dried,  it  must  be  used  in  rather  less  quantity 
than  abovementioned. 


INFLAMMATIONS.  251 

In  the  same  manner  teas  may  be  made  of  rosemary,  balm, 
southern-wood,  etc.,  and  are  convenient  to  prevent  a  thirsty  pa- 
tient taking  too  much  tea  and  coffee,  when  not  good  for  him. 
The  use  of  acid  is  also  avoided. 

Oatmeal  Tea. 

Take  of  oatmeal  a  handful ; 
Boiling  water  a  gallon. 

Mix  in  a  deep  vessel.  Let  the  oatmeal  subside,  which  it  does 
in  half  an  hour,  and  pour  off  the  tea.  By  this  process  hard  water 
is  made  digestible. 

The  main  difference  between  these  recipes  and  those  given  at 
the  close  of  the  last  chapter  is,  that  nutrition  is  not  made  an  ob- 
ject. When  it  is  desired,  the  same  means  are  available  as  have 
been  already  advised  in  lower  fevers. 


252  DIETETICS    IN    SICKNESS. 


CHAPTER  III. 

THE   DIET   AND   REGIMEN  OF   WEAK    DIGESTION. 

CHRONIC  deficiency  of  power  in  the  stomach,  atonic  dyspepsia, 
is  evidenced  by  a  'sense  of  uneasy  distension  in  the  front  of  the 
waist,  coming  on  an  hour  or  so  after  food,  and  often  lasting  till  it 
is  temporarily  relieved  by  the  next  meal  or  by  sleep.  There  is 
no  sharp  pain  on  pressure  —  indeed,  gentle  rubbing  seems  to  give 
relief.  The  sensation  hardly  ever  amounts  to  pain,  except  in 
highly  nervous  or  hysterical  persons,  or  where  a  great  formation 
of  air  gives  rise  to  colicky  spasms.  Portions  of  undigested  food 
are  apt  to  regurgitate,  and  are  rancid  with  butyric  acid.  This  oc- 
curs at  a  later  period  after  food  than  the  more  familiar  "  acidity," 
or  sensitiveness  to  the  normal  acidity  of  the  stomach,  which  is 
found  in  nervous  hyperaesthetic  persons. 

Constipation,  or  what  is  called  "sluggish  liver,"  is  often  a  symp- 
tom which  attracts  the  notice  of  a  patient  and  brings  him  to  a 
physician.  And  most  cases  have  been  already  much  aggravated 
by  the  attempt  to  obviate  the  inconvenience  with  the  aid  of  pur- 
gative drugs.  The  constipation  really  arises  from  the  extension 
of  the  want  of  tone  in  the  stomach  to  the  secretions  and  propul- 
sive movements  of  the  intestines,  and  the  habitual  indulgence  in 
opening  medicine  increases  this.  From  want  of  tone,  also,  the  ilia 
and  colon  dilate,  and  are  blown  up  with  retained  air.  And  the 
dilatation  causes  pain,  especially  in  the  waist  and  under  the  shoul- 
der-blades. 

If  regular,  the  evacuations  are  pale,  scanty,  and  unformed. 
Should  any  excess  in  eating  nitrogenous  food  be  committed,  there 
is  sometimes  a  temporary  diarrhoea  and  fetor  in  what  conies  from 
the  bowels.  Sometimes  the  looseness  is  almost  constant. 

This  condition  of  the  digestive  canal  is  well  demonstrated  by 
the  aspect  of  the  tongue,  the  lips,  and  the  gums.  They  are  pale, 
and  retain  the  impress  of  anything  pressed  upon  them,  and  easily 
bleed.  So  that  the  tongue  bears  marks  of  the  teeth  along  its 


WEAK    DIGESTION.  253 

edge,  and  the  efforts  of  swallowing  elongate  the  uvula.  Sometimes 
streaks  of  blood  which  have  exuded  are  hawked  up,  and  the  tick- 
ling of  the  glottis  by  the  lax  pendent  uvula  causes  a  cough,  and 
the  patient  is  alarmed  by  the  fear  of  pulmonary  consumption. 

Palpitation  of  the  heart,  and  sometimes  intermission  of  the 
pulse,  are  noticed,  especially  where  the  flatulence  is  great.  The 
pulsation  is  rapid  on  excitement,  but  is  soft  and  slow  during 
repose. 

The  urine,  as  a  rule,  is  pale  and  watery,  with  a  low  specific 
gravity,  indicating  thus,  by  the  deficiency  of  urea,  an  imperfect 
nutrition.  The  phosphates  are  also  deficient,  but  still  form  a 
cloud  when  the  fluid  is  subjected  to  heat,  showing  its  abnormal 
deficiency  of  acid.  Care  must  be  taken  that  these  characteristics 
of  the  renal  secretion  do  not  arouse  a  fallacious  fear  of  Bright's 
disease  in  the  kidney. 

The  intellectual  faculties  do  not  appear  to  be  impaired,  but  there 
is  a  heaviness  and  disinclination  for  exertion  which  induces  the 
patient  to  say  they  are,  as  an  excuse  for  his  sluggishness.  If 
sleep  be  indulged  in  during  the  day,  it  is  unrefreshing,  and  often 
leaves  headache  and  weariness  behind  it. 

In  the  case  of  atonic  dyspepsia,  I  have  departed  from  the  gen- 
eral plan  of  this  little  volume  in  giving  details  of  the  symptoms 
of  the  disease,  because  these  symptoms  have  each  a  decided  bear- 
ing on  the  dietetic  treatment.  The  first-named  group  of  sensa- 
tions appear  to  depend  on  the  quantity  which  is  taken  at  once, 
and  are  much  less  perceived  when  small  and  frequent  meals  are 
made  the  rule.  These  moderate  meals  during  the  day  should  be 
reinforced  by  a  light  supper  on  going  to  bed.  And  the  period  of 
waiting  before  breakfast  may  be  made  less  exhausting  by  a  cup  of 
milk  with  a  teaspoonful  of  rum  in  it. 

Fluids  should  be  drunk  in  moderation,  and  never  at  the  com- 
mencement of  the  meal.  For  overdilution  weakens  the  gastric 
juice,  which  is  scanty  at  first;  but  when  it  is  poured  out  more 
copiously,  fluids  assist  the  onward  motion  of  the  chyme  through 
the  pylorus,  and  obviate  that  delay  which  gives  rise  to  the  feeling 
of  uneasiness. 

The  nature  of  the  food  is  of  less  importance  than  its  quantity ; 
but  still  it  has  an  influence.  Rich,  greasy  sauces  are  especially  to 
be  avoided ;  for,  meeting  in  the  stomach  with  the  acidifying  rem- 


254  DIETETICS    IN    SICKNESS. 

nants  of  the  former  meal,  they  rapidly  undergo  the  butyric  fer- 
mentation and  turn  rancid.  No  acid  is  so  disagreeable  to  the 
stomach  and  oesophagus  as  the  butyric;  and  therefore,  when  this 
forms,  relief  is  often  experienced  on  stopping  that  form  of  fermen- 
tation by  another  acid.  A  few  drops  of  diluted  phosphoric  or 
muriatic  acid,  a  teaspoonful  of  lemon-juice,  or  even  a  piece  of  sour 
apple,  or  a  little  Chili  vinegar,  often  palliate  the  distress.  But 
the  wisest  course  is  to  avoid  the  cause. 

The  bill  of  fare  should  be  varied  from  day  to  day,  but  as  simple 
as  possible  at  each  meal.  Considerable  comfort  is  often  gained  by 
dividing  the  animal  from  the  vegetable  food,  taking  one  at  one 
meal  and  the  other  at  another.  Vegetable  food  is  much  less 
likely  to  cause  flatulence  if  taken  alone. 

Vegetables  should  not  be  omitted  from  the  dietary,  or  the  future 
health  will  suifer.  But  such  should  be  selected  as  cause  least  in- 
convenience, and  the  mode  of  dressing  them  adjusted  and  experi- 
mented upon  till  the  patient  finds  how  much  and  how  many  suit 
his  peculiarities.  Spinach  can  almost  always  be  borne  either 
chopped  up,  or  served  as  cabbage,  or  in  soup.  And  so  generally 
can  tomatoes,  squashes,  vegetable  marrows,  Elector's  caps,  salsify, 
scorzonera,  beet  root,  and  French  beans.  Peas  must  be  very 
young  and  soft.  Potatoes  must  be  old,  and  cooked  according  to 
the  recipe  in  the  last  chapter  but  one.  Of  cauliflower  only  the 
friable  white  flower  is  fit  for  eating. 

Raw  fruit  should  never  be  eaten  at  the  end  of  a  meal.  But 
roast  apples,  if  taken  with  a  little  cream  and  hardly  any  sugar, 
are  digestible  enough.  Between  meals  or  as  a  separate  meal,  a 
bunch  of  grapes,  a  few  strawberries,  currants,  or  raspberries  with 
a  crust  of  bread,  aid  rather  than  impede  digestion. 

All  bread  should  be  stale  or  toasted.  The  best  is  that  which  is 
closest  grained  and  most  friable.  If  the  teeth  are  sufficiently 
sound,  crust  is  preferable  to  crumb.  Biscuits  should  be  made 
with  water,  and  not  sweet.  Of  other  farinaceous  food  it  may  be 
remarked  that  almost  all  depends  on  the  cooking.  Pastry,  from 
its  mechanical  texture,  is  very  slow  of  solution,  and  should  be 
cut  out  of  the  bill  of  fare  altogether ;  but  the  same  flour  made  into 
bread  pudding  can  generally  be  tolerated  without  inconvenience. 
Semolina,  tapioca,  and  arrowroot  are  a  safe  variety. 

Cheese  after  dinner  always  disagrees.     But  it  is  nutritious,  and 


WEAK    DIGESTION.  255 

is  often  missed  much  by  the  patient.  If  so,  let  him  try  it  toasted 
as  a  separate  meal.  It  should  be  quite  new,  cut  into  thin  slices, 
buttered  and  basted  while  toasting  with  a  little  cream.  Let  it  be 
brought  up  on  a  hot-water  plate,  and  not  allowed  to  become  hard 
and  tough. 

Meat  should  be  eaten  twice  a  day.  It  ought  not  to  be  cooked 
a  second  time.  A  table  of  precedence  in  comparative  digestibility 
is  given  in  a  former  part  of  this  volume,1  which,  as  far  as  the 
butcher's  meat  and  game  are  concerned,  is  applicable  to  the  selec- 
tion of  food  in  atonic  dyspepsia..  If  any  one  can  extend  his  ac- 
quaintance as  far  as  "roast  beef,"  he  may  consider  that  he  is  not 
an  atonic  dyspeptic. 

The  wholcsomest  fish  for  weak  digestions  are  boiled  flounders, 
whiting,  haddock,  sole,  plaice,  brill,  perch,  among  which  a  free 
choice  may  be  made.  Cod  must  be  taken  with  more  caution.  It, 
however,  bears  cooking  by  dry  heat  better  than  the  aforenamed, 
and  if  well  done  in  cutlets  suits  delicate  stomachs  often  better 
than  the  others.  Rich  and  oily-fleshed  fishes,  such  as  eels,  her- 
rings, pilchards,  sprats,  salmon,  mullet,  and  those  of  very  firm  tex- 
ture, such  as  turbot,  tunny,  pike,  had  best  not  be  attempted  by 
invalids  at  all.  The  condiment  should  be  a  squeeze  of  lemon  or 
Duke  of  York's  pepper  sauce. 

It  must  be  observed  that  so  powerful  is  the  influence  of  the 
mind  over  the  body  that  nothing  is  more  common  than  for  persons 
to  exhibit  wonderful  idiosyncrasies  respecting  their  capability  of 
digesting  peculiar  articles  of  food.  Those  who  have  a  strong  will 
seem  able  by  perseverance  to  use  themselves  to  assimilate  almost 
anything  assimilable.  The  gratification  of  desire  puts  the  nervous 
system  into  a  state  most  favorable  to  the  secretion  of  gastric  juice, 
and  the  thwarting  of  a  prejudice,  however  whimsical,  upsets 
temper  and  stomach  at  the  same  time. 

Some  dyspeptics  get  into  a  bad  habit  of  erasing  from  their 
future  bill  of  fare  everything  that  has  once  seemed  to  be  followed 
by  inconvenience.  The  result  is  an  unwholesome  monotony  of 
wrongly  selected  victuals,  and  a  despairing  resignation  to  a  need- 
less abstinence.  Let  them  on  the  other  hand  take  the  more  hope- 
ful course  of  adding  to  their  dietary  everything  that  they  have 

1  Pp.  114,  115. 


256  DIETETICS    IN    SICKNESS. 

once  found  to  agree,  and  they  will  have  a  choice  nearly  as  exten- 
sive as  their  robust  brethren  could  wish.  If  one  cook  cannot 
make  a  coveted  article  digestible,  let  them  try  another. 

Sugar  at  the  latter  end  of  meals  certainly  generates  an  excess 
of  organic  acids,  and  is  to  be  avoided.  But  yet,  in  moderation,  it 
promotes  (as  observed  by  Blonlot)  the  flow  of  gastric  juice;  so 
that  the  custom  adopted  by  Oriental  nations1  of  taking  a  few 
bonbons  and  sweeties  is  in  accordance  with  reason,  and  might 
prudently  be  experimented  on  in  this  country.  An  excellent 
dietetic  fillip  to  the  appetite  is  a  couple  of  pepsin  lozenges,  or  the 
same  quantity  made  into  pills  with  sugar. 

Fermented  liquors  in  atonic  dyspepsia  are  apt  to  cause  a  con- 
gestive flushing  of  the  brain,  face,  and  neck,  and  a  throbbing  of 
the  arteries.  This  may  be  viewed  as  an  external  evidence  of  what 
is  going  on  unfelt  in  the  abdomen.  If  these  symptoms  are  promi- 
nent, a  state  of  things  is  indicated  not  at  all  favorable  to  digestion, 
and  we  may  be  sure  that  alcoholic  stimulants,  in  the  quantity  taken, 
are  injurious.  But  that  does  not  prove  that  in  less  quantity,  or 
more  dilute,  they  may  not  be  beneficial.  There  is  a  quantity,  capa- 
ble of  being  arrived  at  in  each  separate  case  by  experiment,  par 
la  vole  d'exclusion,  which  just  succeeds  in  stimulating  the  appetite 
without  flushing  the  face.  Very  small,  indeed,  that  quantity  is 
.sometimes ;  yet  it  is  an  actual  measurable  quantity,  not  "  infini- 
tesimal." It  lias  a  genuine  physiological  effect,  to  be  accounted 
for  by  its  observed  action  on  the  nervous  system,  and  missed 
when  it  is  not  taken.  I  have  known,  for  instance,  the  small  sip 
of  wine  drunk  at  the  Sacrament  of  the  Lord's  Supper  to  make  a 
decided  difference  for  good  in  the  digestion  of  an  immediately 
following  meal. 

If  a  patient  has  the  common  sense  to  regulate  himself  accord- 
ing to  the  forementioned  guide,  there  is  not  much  need  for  inter- 
fering with  the  nature  of  the  vintage  he  patronizes.  Port,  Bur- 
gundy, and  dry  sherry  agree  if  limited  to  tablespoonfuls.  But  if 
he  persists  in  neglecting  the  warning,  then  we  should  persuade 
him  to  take  claret,  hock,  or  Capri.  Not  that  these  are  really 
better  for  him,  but  they  are  more  dilute.  Beer,  sweet  champagne, 
and  sparkling  wines  in  general,  almost  always  give  rise  to  fer- 

1  See  Kawlinson's  notes  to  Herodotus,  b.  i. 


WEAK    DIGESTION.  257 

mentation.  Some  persons  find  it  suits  them  not  to  have  any  al- 
coholic drink  during  the  day,  but  to  take  a  glass  of  hot  whisky 
toddy  on  retiring  to  rest. 

Tea  is  most  refreshing  to  the  dyspeptic  if  made  in  the  Russian 
fashion,  with  a  slice  of  lemon  on  which  a  little  sugar  candy  has 
been  sprinkled,  instead  of  milk  or  cream.  One  small  cup  of  an 
evening  is  enough,  and  at  breakfast  its  place  is  well  taken  by 
cocoa  made  from  the  nibs. 

Constipation  is  effectually  obviated  by  the  habitual  employment 
of  green  vegetables,  porridge,  brown  bread,  charcoal,  and  a  few 
other  articles  of  diet  containing  a  good  deal  of  unirritative  matter 
which  yet  is  not  dissolved  by  the  solvents.  Olive  oil  and  mustard 
also  assist  in  effecting  the  same  object.  But  it  is  better  to  allow 
the  continuance  of  constipation  than  to  administer  purgatives,  and 
it  is  wise  from  the  first  to  try  and  disabuse  your  patients  of  the 
fallacy  that  the  bowels  not  open  every  twenty-four  hours  are  in 
mischief. 

"Where  there  is  a  looseness,  from  the  food  passing  away  undi- 
gested, a  few  drops  of  laudanum  at  night  will  oft«n  give  it  a 
chance  of  solution  by  detaining  it  in  the  bowels, 

"  Stomach  cough  "  and  "Stomach  sore  throat,"  described  at  the 
beginning  of  the  chapter,  are  best  treated  by  not  sitting  down  to 
breakfast  without  having  gargled  the  throat  with  alum  water,  or 
sprinkled  the  back  of  the  fauces  with  dilute  hydrosulphurous 
acid.  If  the  mouth  is  foul  and  the  breath  heavy  of  a  morning,  a 
cleansing  with  a  weakjsvash  of  Condy's  solution  is  also  a  good 
preliminary  to  eating. 

Palpitation  of  the  heart  and  of  the  abdominal  aorta  are  almost 
always  made  worse  by  special  remedies  directed  to  them,  because 
the  thoughts  are  thereby  induced  to  concentrate  themselves  on  the 
suffering  organs.  They  do  not  lead  to  any  organic  affection,  and 
are  useful  as  an  index  to  the  improvement  or  decline  of  the 
patient. 

A  low  specific  gravity  of  the  urine  is  an  indication  for  the  use 
of  tonic  medicines.  An  abnormally  high  specific  gravity  shows 
that  more  vegetables  should  be  eaten. 

When  the  medical  attendant  thinks  fit  in  a  case  of  atonic  dys- 
pepsia to  order  quinine  and  strychnine,  alone  or  in  combination, 
or  iodide  of  potassium,  care  should  be  exercised  not  to  eat  within 

17 


258  DIETETICS    IN    SICKNESS. 

an  hour  before  or  after,  as  the  mixing  of  the  drug  with  food  in 
the  stomach  diminishes  the  efficiency  of  both.  But  rhubarb  or 
aloes,  in  the  exceptional  cases  where  they  are  advisable,  may  be 
used  with  advantage  along  with  the  meal ;  while  pepsin  is  bene- 
ficial only  in  that  combination,  and  iron  should  be  taken  by  itself 
after  food.  It  is  right,  however,  to  say  iron  rarely  suits  well  for 
long  together.  Cod-liver  oil,  a  good  dietetic  tonic  in  some  in- 
stances of  this  form  of  disease,  agrees  best  the  last  thing  at  night, 
and  made  up  with  a  little  soda  and  milk.  During  the  day,  it  is 
apt  to  turn  rancid,  and  return  unpleasantly.  Aromatics  (such  as 
teas  or  infusions  of  cloves,  cinnamon,  horse-radish,  canella,  and 
calumba),  as  also  bitters  (such  as  quassia,  hops,  and  wormwood), 
are  useful  only  just  before  meals.  I  have  seldom  found  mere  bit- 
ters do  good. 

The  employment  of  alkaline  mineral  waters  containing  soda, 
especially  Apollinaris  and  dilute  Vichy  water,  is  sometimes  a 
great  comfort.  The  only  way  in  which  we  can  explain  this  is 
that  alkalies,  as  observed  by  Corvisart,  by  a  sort  of  antagonism 
augment  the  secretion  of  gastric  juice.  They  should  be  drunk, 
then,  at  the  commencement  of  the  meal,  and  not  afterwards,  when 
they  would  neutralize  what  is  already  secreted. 

Mineral  acids,  the  most  digestible  of  which  is  the  phosphoric, 
are  best  on  a  full  stomach. 

As  respects  the  general  regimen,  it  should  be  of  a  bracing  char- 
acter. As  much  time  as  possible  should  be  spent  in  the  open  air, 
but  exercise  should  not  be  carried  to  the  point  of  producing  over- 
fatigue.  Riding  in  company,  especially  the  company  of  ladies,  is 
perfection ;  but  bowls,  archery,  croquet,  and  lawn  tennis,  are  not 
to  be  despised  as  wholesome  amusements.  Along  with  moderate 
exercise,  sound  rest,  especially  at  night,  in  a  quiet  bed,  should  be 
secured ;  but  coddling  in  hot  rooms,  sleeping  by  day,  and  giving 
way  to  slight  feelings  of  discomfort,  or  the  avoidance  of  society 
under  pretence  of  fearing  fatigue,  must  be  discouraged. 

An  excellent  device  for  invigorating  the  circulation,  especially 
for  women,  is  to  take  the  morning  bath  by  sitting  in  warm  water 
and  having  a  bucket  of  cold  water  poured  down  the  spine  from 
the  nape  of  the  neck,  and  then  being  rubbed  dry  immediately 
with  a  rough  dried  towel. 

The  quality  of  the  water  used  by  atonic  dyspeptics  is  a  matter 


WEAK    DIGESTION.  259 

of  serious  consideration.  Hard  chalky  water  produces  flatulence, 
and  frequently  a  grinding  neuralgic  pain  in  the  epigastrium,  so 
long  as  its  use  is  persisted  in ;  and  the  brighter  and  more  spark- 
ling it  is,  the  worse  it  seems  to  agree.  Chalybeate  waters,  as  a 
daily  driok,  though  the  taste  of  iron  be  very  slight  in  them,  in  a 
few  months  produce  a  peculiar  debility  and  anamia ;  even  though 
at  first,  and  when  taken  as  a  medicine  fora  short  course,  they  had 
exhibited  quite  an  opposite  effect. 

The  best  places  of  residence  are  high,  dry,  and  bracing.  The 
air  of  the  Surrey  and  Sussex  Downs,  or  such  a  combination  of 
heather,  fir-woods,  and  a  sandy  soil,  as  is  to  be  found  on  Ascot 
Heath,  seem  the  best  specimens  one  can  quote.  It  may  be  added 
that  the  last-named  enjoys  the  advantage  of  a  chalybeate  spring, 
a  short  course  of  which  will  benefit  those  cases  where  atonic  dys- 
pepsia has  induced  scantiness  of  the  evacuations  peculiar  to  wromen, 
or  strongly  marked  anemia.  It  agrees  better  than  other  forms 
of  steel ;  which,  as  previously  noticed,  is  seldom  well  tolerated  in 
pure  atonic  dyspepsia. 

The  cookery  in  cases  of  this  complaint  can  hardly  be  too  simple. 
The  appetite  should  not  be  tempted  by  savory  compounds,  but 
by  so  preparing  the  article  that  its  peculiar  taste  should  be  made 
prominent  and  attractive,  and  at  the  same  time  its  texture  made 
more  soluble  and  digestible.  The  chapter  on  cookery  in  the  first 
part  of  this  work  may  supply  a  few  hints,  and  the  few  recipes 
that  follow  are  efforts  in  the  same  direction. 

Duke  of  York's   Universal  Sauce. 
(Pepys's  Diary,  February  10,  1668-9.) 

Pound  hard  dried  toast  and  a  tablespoonful  of  peppercorns  in  a 
mortar,  and  boil  them  with  an  equal  quantity  of  chopped  parsley 
(or  any  other  herb  liked)  and  a  dessertspoonful  of  salt  in  a  small 
teacupful  of  water.  Add  a  teaspoouful  of  white  vinegar,  Tarra- 
gon vinegar,  or  lemon -juice. 

Relish  for  Fish. 

Fish  is  made  more  digestible  and  has  its  flavor  brought  out  by 
a  few  drops  of  lemon-juice  squeezed  over  it. 


260  DIETETICS    IN    SICKNESS. 


White  Mayonnaise  Sauce. 

Put  the  yolk  of  a  hard-boiled  egg  in  a  small  basin  ;  break  it 
up  fine  with  a  wooden  spoon,  adding  a  pinch  of  salt  and  a  pinch 
of  pepper.  Then  keep  on  stirring  briskly,  while  you  pour  in, 
drop  by  drop,  the  best  sweet  olive  oil  to  the  extent  of  about  two 
dozen  teaspoonfuls.  With  each  eighth  teaspoonful  of  oil,  add  a 
teaspoonful  of  white  vinegar.  Tarragon  vinegar,  elder  vinegar, 
or  otherwise  seasoned  vinegar  can  be  used  by  those  who  like  them ; 
or  a  tablespoonful  of  French  mustard  may  be  added. 

Soiled  Flounders. 

Put  the  flounders  in  a  stewpan  with  a  moderate  quantity  of 
boiling  water,  seasoned  with  a  little  salt;  take  off  the  scum,  and 
continue  the  boiling  ten  minutes.  Drain  the  fish  on  a  fish-plate 
before  the  fire,  and  serve. 

Rice  Milk  (Gouffe). 

Blanch  in  plenty  of  water,  2J  ozs.  of  best  Carolina  rice; 

Cool  with  plenty  of  cold  water,  and  drain ; 

Boil  3  pints  of  milk  in  a  2-quart  stewpan ; 

Mix  the  rice  in  the  milk,  and  stir  on  the  fire  till  boiling; 

Add  a  lump  of  sugar  and  a  small  pinch  of  salt — say  J  oz.  of 

each; 
Boil  for  an  hour ;  serve. 

Other  milk  soups — vermicelli,  semolina,  tapioca,  etc. — are  pre- 
pared in  the  same  way,  and  form  an  excellent  light  supper. 

Potato  Surprise. 

Scoop  out  the  inside  of  a  sound  potato,  leaving  the  skin  at- 
tached on  one  side  to  the  hole,  as  a  lid.  Mince  up  fine  the  lean 
of  a  juicy  mutton  chop,  with  a  little  salt  and  pepper,  put  it  in  the 
potato,  pin  down  the  lid,  and  bake  or  roast.  Before  serving  (in 
the  skin),  add  a  little  hot  gravy,  if  the  mince  seems  too  dry. 


GOUT    AND    RHEUMATISM.  261 


CHAPTER  IV. 

GOUT  AND   RHEUMATISM. 

THERE  can  be  no  sort  of  doubt  that  good  cheer  indulged  in, 
either  by  himself  or  his  ancestors,  is  the  principal  cause  of  every 
man's  gout.  Even  where  it  is  hereditary,  the  patient  will  gener- 
ally be  found  to  have  assisted  in  bringing  it  on  by  his  own  love 
of  evil  things.  The  cases  where  it  is  traceable  to  lead  poison,  pe- 
culiar exposure  to  cold  and  damp,  and  a  few  other  rare  causes, 
need  not  trouble  us  much,  as  when  they  do  occur  their  pathology 
is  very  obvious. 

But  if  it  is  due  to  good  cheer,  shall  we  not  be  able  to  detect  the 
identical  article  or  articles  out  of  whose  pleasant  substance  is 
made  the  scourge  to  lash  us  ?  Shall  we  not  be  able,  by  exclud- 
ing this,  to  enjoy  the  cup  without  the  bitter  drop  at  the  end  of  it? 

Those  of  our  fellow-citizens  who  drink  champagne,  port,  Ma- 
deira, sherry,  Burgundy,  London  porter,  are  the  most,  of  all  the 
population,  disposed  to  have  gout.  These  liquors  contain  a  pe- 
culiarly large  proportion  of  alcohol;  and  so,  exclaim  the  growers 
of  light  wines  and  total  abstainers,  alcohol  is  the  cause  of  gout. 
But  wait — observe  the  Glasgow  laborer  and  the  Irish  peasant, 
and  the  Swede  and  Russ,  who  consume  in  the  form  of  spirits  six 
times  the  amount  of  alcohol  that  we  do.  They  are  quite  free  from 
gout. 

Is  it  the  acid  in  these  drinks  ?  Hardly — for  they  really  do  not 
contain  any  marked  excess.  Or  the  sugar?  No — or  sweetened 
tea  would  be  equally  noxious. 

Or  is  it  the  peculiar  combination  of  all  those  ?  Possibly.  But 
I  think  a  more  rational  explanation  is  that  the  classes  who  are 
rich  enough  to  enjoy  these  luxuries  are  rich  enough  to  enjoy  other 
luxuries  also.  In  fact,  the  cases  of  gout  originating  in  the  indi- 
vidual himself,  without  his  being  able  to  throw  any  blame  upon 
his  pedigree,  occur  in  those  who  daily  consume  a  larger  quantity 
of  nutritious  food  than  their  bodies  require,  or  than  can,  by  the 


262  DIETETICS    IN    SICKNESS. 

assimilative  powers  they  possess,  be  converted  into  useful  muscle. 
Hence  there  is  an  accumulation  of  oxidizable  matters  which  fail 
to  attain  the  end  of  their  chemical  transformations,  which  do  not 
become  urea.  So  that  there  remains  in  the  system  an  excess  of 
them,  especially  of  uric  acid,  convertible  into  urate  of  soda,  the 
characteristic  deposit  in  gout.  Other  contributors  to  the  produc- 
tion of  gout  run  hand  in  hand  with  the  over-eating  of  meat,  rather 
than  with  indulgence  in  fermented  liquors  only.  Laziness  can 
hardly  be  dissociated  from  gluttony — picture  the  latter,  and  you 
picture  the  former.  And  laziness  can  easily  be  understood  to  act 
in  the  same  direction,  by  arresting  the  oxidation  which  is  the  re- 
sult of  due  exercise.  Immoral  self-indulgence  of  another  sort  aids 
the  development  of  gout  by  the  exhaustion  of  the  nervous  system 
which  it  induces  without  corresponding  muscular  action.1  And 
the  same  may  be  remarked  of  intellectual  pursuits,  a  love  for 
which  has  been  noticed  frequently  to  go  along  with  gout,  and 
which  tempts  the  possessor  to  use  his  brain  and  let  his  limbs  lan- 
guish. Damp  cold  also,  by  weakening  and  retarding  the  circula- 
tion, helps  in  a  minor  degree  the  evil  effects  of  gorging  the  diges- 
tive organs  with  nitrogenous  food.  Such  seems  to  me  the  history 
of  the  origination  of  gout  in  the  constitution. 

The  part  played  by  fermented  liquors  seems  rather  the  bring- 
ing on  of  the  acute  attack,  of  which  almost  all  habitual  sufferers 
can  cite  an  instance.  One  man  takes  some  port  wine,  which  he 
has  left  off  for  years,  and  the  same  night  is  woke  up  with  the  hor- 
ribly familiar  stab  in  the  small  joints.  Another  drinks  a  few 
glasses  of  champagne,  and  feels  his  foot  twinge  and  swell  before 
he  leaves  the  table. 

This  consequence  of  an  unhabitual  excess  is  of  the  greatest  im- 
portance in  diagnosis.  For  we  may  lay  it  down  as  universally 
true  that  when  a  few  glasses  of  wine  or  beer  are  followed  soon  by 
the  inflammation  of  a  joint  or  pain  in  a  trunk  nerve,  the  inflam- 
mation or  pain  is  of  a  gouty  nature.2 

The  views  above  stated  as  to  the  origin  of  gout  can  suggest 
but  one  line  of  preventive  treatment.  The  children  of  gouty 
families  should  be  brought  up  to  a  life  of  strict  abstemiousness 

1  \vatfiE%.ov$  ~Ra.KX.ov  nal  hxrifiefavf  '  A^podirrj^ 
Tevvarat  QvyaTTjp  AvaifiElfa  Hodaypa. — Anihol.  Graven. 

2  Cyr,  dc  1'Alimentation,  part  ii,  chap,  ii,  article  1. 


GOUT    AND    RHEUMATISM.  263    - 

and  muscular  activity — "to  scorn  delights  and  live  laborious 
clays."  They  must  not  compound  for  temperance  in  alcohol  by 
indulgence  in  dainty  meats,  sweet  pastry,  soft  beds,  or  idleness. 
At  the  same  time  I  would  not  encourage  them  to  an  ambitious 
athleticism,  to  glorying  too  much  in  their  strength.  The  result 
of  this  very  often  causes  a  reactionary  depression  at  the  period  of 
middle  life,  which  persons  hereditarily  healthy  can  resist,  but 
which,  in  the  case  of  those  with  ancestral  tendency  to  gout  devel- 
ops the  disease. 

From  the  earliest  years,  vegetables  should  form  a  considerable 
portion  of  the  dietary.  They  should  be  furnished  in  great  variety,  ' 
so  that  the  young  may  acquire  a  taste  and  a  digestion  for  them.  I 
The  various  sorts  of  "  meagre  "  (or  meatless)  soups  found  in  cook- 
ery books,  and  others  which  an  inventive  miud  will  suggest, 
should  be  habitual.  Porridge  for  breakfast  may  be  taken  to  any 
amount — what  men  are  grown  upon  it  in  Northumberland  and 
the  North  of  Yorkshire!  And  in  buttermilk  will  be  found  the 
best  quencher  of  the  thirst  and  nourishing  digester  of  other  vic- 
tuals as  well  as  itself.  As  they  grow  up,  the  young  people  should 
be  impressed  with  the  reason  of  this  temperance,  and  urged  to 
persevere  in  it,  not  only  for  their  own  sakes,  but  as  a  moral  duty 
for  the  sake  of  their  descendants.  A  man  has  a  right  to  choose 
for  himself  one  of  two  paths,  but  he  has  no  right  to  lead  involun- 
tary followers  along  that  which  seems  the  pleasantest  at  the  mo- 
ment. 

If  the  tackling  with  the  disease  by  diet  and  regimen  be  under- 
taken only  after  the  development  of  it  has  taken  place,  the  task  is 
much  more  difficult,  but  not  a  fair  subject  for  despair.  Dr.  Gar- 
rod,  than  whom  none  has  sought  more  diligently  for  medicinal 
remedies  for  gout,  or  more  advanced  our  knowledge  of  its  path-  "Sx« 
ology,  says  that  "  if  a  gouty  man  could  entirely  lay  aside  his  usual 
habits,  and  follow  in  all  respects  the .  dictates  of  nature,  there 
would  probably  be  little  need  to  seek  relief  from  medicine."1  By 
"nature"  must  be  meant  the  higher  nature,  reason  or  common 
sense;  for  man's  desires  are  so  perverted  by  the  prejudices  of  edu- 
cation, and  by  moral  and  physical  inheritance,  that  one  cannot 
well  trust  to  their  guidance  in  the  treatment  of  disease.  But  by 

1  Keynolds's  System  of  Medicine.,  vol.  i,  p.  875. 


264  DIETETICS    IN    SICKNESS. 

rational  management,  it  seems  pretty  certain  that  gout  may  be  so 
far  checked  as  will  enable  the  patient  to  enjoy  life,  to  live  to  his 
full  term,  and  to  hand  down  an  untainted  constitution  to  his  suc- 
cessors. 

An  honest  trial  must  be  made,  for  three  months  at  least,  of  an 
entire  abstinence  from  all  alcohol,  except  a  little  weak  claret  and 
water  at  dinner.  If  in  that  time  weight  is  gained,  or  not  lost,  let 
the  rule  of  abstinence  be  established  for  good  and  all. 

If  it  is  found  that  alcohol  cannot,  in  the  judgment  of  a  compe- 
tent temperate  medical  man,  be  left  off,  it  will  be  best  to  take, 
as  the  habitual  form  of  it,  hbllands  and  soda  water.  The  quan- 
tity of  spirit  should  never  exceed  a  small  wineglassful,  and  should 
be  taken  either  at  dinner,  or,  in  cases  of  sleeplessness,  at  bedtime, 
but  not  at  both. 

Meat  should  be  eaten  but  once  a  day'.  In  other  respects,  the 
advice  given  in  the  last  chapter  as  to  food  and  cookery  may  be 
held  valid  for  gouty  persons  as  well  as  atonic  dyspeptics.  The 
obedience  of  the  cook  to  orders  is  of  paramount  importance;  and 
it  will  be  well  also  to  wa.rn  our  patient  not  to  be  trying  this  or 
that  dish  as  good  for  gout,  at  the  bidding  of  officious  friends,  but 
to  use  his  own  judgment,  usually  sounder  than  theirs  and  also 
strengthened  by  self-interest. 

The  digestion  of  gouty  persons  is  usually  much  improved  by  a 
winter  sojourn  in  the  dry  warm  air  of  the  islands  and  highlands 
which  get  the  benefit  of  Mediterranean  breezes.  I  am  unwilling 
to  injure  one  place  by  mentioning  another,  and  am  disposed  rather 
to  enlarge  upon  the  general  qualities  by  which  that  great  nurse  of 
the  civilization  of  the  human  race,  the  Mediterranean,  can  earn 
still  that  gratitude,  though  we  arc  out  of  her  leading  strings. 

Without  seeking  for  recondite  cosmic  influences,  take  the  map 
of  Europe,  and  consider  the  obvious  characters  of  the  waves  and 
winds.  The  supply  of  fresh  water  brought  by  rivers  to  the  Medi- 
terranean is  very  much  less  than  that  which  comes  by  the  Gulf 
Stream  from  the  Polar  glaciers  to  the  Atlantic.  It  is  therefore 
salter,  and  would  be  salter  still,  and  in  course  of  generations  all 
salt,  were  not  a  vast  stream  of  Atlantic  water  flowing  in  through 
the  Straits  of  Gibraltar.  Being  salter,  it  is  more  ready  to  remove 
moisture  from  the  air,  and  less  ready  to  part  with  it  to  the  air 
under  varying  temperatures  than  the  ocean  which  surrounds  us  at 


GOUT    AND    RHEUMATISM.  265 

home.  Its  temperature  also  is  more  equalized  throughout ;  there 
are  not,  as  with  us,  hot  and  cold  streams  the  vapors  from  which 
meet  in  the  air  and  precipitate  their  watery  burden  on  the  earth. 
So  that  the  atmosphere  is,  in  the  first  place,  clearer,  or  has  a  minor 
degree  of  hygrometric  saturation,  than  in  the  British  Isles,  and  in 
the  second  place  is  less  rainy. 

Of  course  there  is  rain,  and  of  course  there  is  east  wind  and 
north  wind  in  Italy  as  elsewhere ;  but  there  is  not  that  continuous 
depressing  influence  of  the  combination  of  a  cold  wind  with  a  sat- 
urated air  which  we  have.  Then  the  avoidance  of  these  black  un- 
Italian  days  does  not  involve  an  imprisonment  of  a  week  or  two 
in  the  house;  and,  in  travelling,  a  change  of  residence  of  a  few 
miles  will  often  put  you  completely  under  shelter.  Those  who  go 
abroad  with  an  old-fashioned  guide-book,  or  take  their  ideas  of 
Italy  from  the  queer  little  pictures  in  blue  body  color  that  used 
to  adorn  our  nurseries,  may  be  found  grumbling,  but  those  who 
have  ever  tried  to  travel  in  England,  and  have  the  faculty  of 
comparison,  will  be  well  content.  When  they  see  the  deep  in- 
digo horizon,  the  mark  of  extra  saltness-in  ocean,  which  so  gener- 
ally bounds  the  traveller's  landscape  in  Mediterranean  lands,  they 
will  bless  it  for  the  clear  air  of  which  it  is  not  only  the  indication 
but  the  cause. 

The  high  temperature  of  the  great  body  of  water,  so  intimately 
intermingled  with  the  land,  preserves  that  of  the  air  from  the  va- 
riations which  we  experience.  This  is  of  course  most  especially 
the  case  on  the  coast,  but  even  inland  it  may  be  experienced.  The 
sole  exception  is  that  of  certain  spots  in  the  immediate  vicinity  of 
snow-clothed  mountains,  the  air  blowing  over  which  in  the  early 
spring  is  much  chilled.  So  that  in  such  places  as  Florence,  for 
example,  a  change  of  wind  from  q  sea-breeze  to  a  Tramontana 
may  cause  a  very  sudden  fall  of  the  thermometer.  But  yet  the 
even  temperature  of  Italy  as  a  whole,  compared  with  England  as 
a  whole,  must  be  allowed;  its  exposed  climates  are  less  variable 
than  our  exposed  climates,  and  its  sheltered  nooks  more  com- 
pletely sheltered  than  ours. 

There  is  a  higher  amount  and  degree  of  sunlight  than  in  our 
skies,  so  that  all  the  chemical  actions  in  the  animal  body  must  be 
intensified.  A  conspicuous  evidence  of  this  is  the  readiness  with 


266  DIETETICS    IN    SICKNESS. 

which  the  skin  of  the  face  becomes  tanned  even  in  the  short  and 
fresh  winter  days. 

Again,  the  nervous  system  is  much  more  awake  to  the  effects 
of  alcohol;  so  that  instinctively  less  quantities  are  taken  to  pro- 
duce the  required  effects.  There  are  south  of  the  Alps  very  few, 
if  any,  water  drinkers ;  but  there  are  also  very  few  indeed  who  in- 
dulge in  strong  drink.  One  does  not  "feel  to  want  it."  A  single 
glass  of  Orvieto  or  Capri  there  seems  to  produce  as  much  exhila- 
rating relief  as  an  allowance  of  the  domestic  port  or  sherry  con- 
taining five  times  the  quantity  of  spirit.  And  not  only  is  it  felt 
superfluous,  but  positive  discomfort  is  felt  as  the  immediate  effect 
of  what  appear  to  a  stranger  moderate  doses  of  alcohol. 

A  corresponding  observation  may  be  made  in  respect  of  animal 
food.  Less  is  hankered  after  by  the  invalid,  and,  moreover,  a 
less  rich  or  fat  meat  than  in  England.  Without  a  failure  of 
appetite,  he  yet  feels  satisfied  with  a  smaller  quantity. 

In  Italy  and  Spain  sleep  is  less  profound,  and  easier  shaken 
off  and  dispelled  by  slight  disturbances.  This  light  and  short  re- 
pose is  soon  found  to  be  the  custom  of  the  country,  and  the  mind 
being  set  at  rest  is  satisfied  with  it. 

There  are  no  lands  where  there  is  so  much  variety  to  divert  the 
mind  from  preying  on  its  own  thoughts  as  these.  It  may  be 
doubted  whether  the  past,  the  present,  or  the  future  offers  most 
to  attract  the  attention.  If  none  of  the  strata  of  historical  relics 
interest  the  traveller,  he  can  still  hardly  help  feeling  their  present 
picttiresqueness,  and  the  loveliness  of  the  forms  and  colors  by 
which  they  are  surrounded  ;  while  to  the  social  or  political  obser- 
ver the  spectacle  of  a  naturally  intellectual  and  industrious  people, 
long  restrained  by  untoward  circumstances,  and  now  at  length 
bursting  out  for  good  and  for  evil  into  new  life,  is  unique.  He 
desires  to  live,  were  it  only  to  see  what  becomes  of  them. 

Now  reflect  how  these  various  agencies  may  act  on  the  human 
body.  The  dryness  of  air,  without  excessive  heat  or  cold,  renders 
it  unnecessary  for  mucous  membranes  to  put  on  their  slimy  coats 
of  mucus.  They  are  in  a  more  active  condition  for  the  work  of 
absorbing  oxygen,  digesting,  extracting  nutriment  or  water,  or 
whatever  else  they  are  required  to  do.  They  are  filled  with  blood, 
and  pass  it  on  rapidly  with  its  fresh  burden  of  renewed  life  to  the 


GOUT    AND    RHEUMATISM.  267 

tissues.  So  that  the  disintegration  and  removal  of  the  effete  prod- 
ucts that  cause  gout  is  actively  promoted. 

The  evenness  of  temperature  renders  it  possible  for  all,  invalids 
included,  to  he  a  great  deal  in  the  open  air,  and  take  the  exercise 
which  has  been  described  as  so  essential  to  those  of  gouty  consti- 
tution. 

The  action  of  sunlight  in  reddening  the  blood  is  familiar  to 
even  the  poets.  The  etiolated  plant  of  northern  climes  is  quickly 
by  it  rendered  crisp  and  hardy,  and  the  same  effect  may  be  in- 
ferred to  take  place  in  the  etiolated  animal.  It  is  of  great  im- 
portance in  atonic  gout. 

Spite  of  all  the  arguments  of  philanthropists,  alcohol  will  always 
remain  an  evil  necessity  to  brain-working  populations  in  northern 
climes.  I  do  not  know  but  that  its  occasional  use  is  a  necessity 
in  all  climes.  But  certainly  a  little  goes  further  in  the  south,  and 
therefore  less  is  requisite,  if  any.  Thus  is  avoided  the  temptation 
to  the  slight  daily  excess,  which  is  the  most  dangerous  temptation 
to  the  gouty. 

It  is  not  alone  on  the  passing  traveller  that  Italy's  special  (I 
will  not  call  it  "fatale)  dono  di  bellezza"  acts.  There  is  scarce  a 
peasant  who  is  not  proud  of  the  external  aspect  of  his  country,1 
and  I  am  not  at  all  sure  that  this  feeling  is  not  as  powerful  an 
a— istant  as  any  material  agency  in  enabling  him  to  live  and 
flourish  contentedly  on  what  would  starve  or  drive  into  melan- 
choly madness  an  English  convict  or  pauper.  Do  not  set  down 
this  as  sentimentalism  or  artistic  whim.  Consider  how  continu- 
ally the  converse  of  the  experiment  is  impressed  upon  us  by  blue- 
books  and  sanitary  reporters,  who  are  constantly  repeating  that  a 
monotonous  colorless  life,  such  as  finds  its  exaggerated  type  in 
solitary  confinement,  renders  absolutely  requisite  an  excessive 
quantity,  and  under  other  conditions  an  umvholesomely  stimulat- 
ing quality,  of  food,  to  preserve  in  health  the  mind  and  body, 
although  no  complaint  is  made  by  the  sufferer.  Why  then  should 

1  A  genuine  Italian  will  often  prefer  his  country's  praises  to  liis  own  in 
whimsical  ways.  At  Salerno  we  commended  a  souffle'  to  H  waiter,  who  was 
the  author  of  the  delicacy:  "Call  that  well  made?"  said  he;  "  why  every 
little  lad  in  Salerno  can  make  as  good  a  one — Si,  signori,  ogni  rnga/z'  di 
dieci  anni  nella  citta — and  there  are  thirty  thousand  inhabitants!"  Untrue 
of  course,  but  patriotic. 


268  DIETETICS    IN    SICKNESS. 

it  not  be  true  that  the  daily  life  among  picturesque  and  cheery 
scenes  saves  the  victuals,  although  the  benefited  are  ignorant  of 
their  blessings  ? 

But  it  is  indubitably  for  the  stranger,  as  Filicaja  complains  in 
his  touching  sonnet,  that  this  banquet  of  sweets  is  principally 
spread.  The  temporary  resident  profits  more  than  the  native  by 
the  fair  scenes  and  their  associations,  by  their  ennobling  and  rous- 
ing effect  on  the  mind,  and  through  the  mind  on  the  body.  They 
have  for  him  the  additional  charm  of  variety  and  novelty. 

I  have  dwelt  somewhat  lengthily  on  the  effects  of  a  warm  tonic 
climate  in  this  chapter,  not  because  its  benefits  are  exclusively  or 
even  principally  confined  to  the  gouty,  but  to  finish  up  the  subject 
as  a  whole,  and  be  enabled,  when  speaking  of  other  diseases, 
merely  to  refer  to  it. 

The  most  expedient  form  of  exercise  for  a  gouty  person  is  rid- 
ing, as  he  will  not  be  deterred  from  it  by  a  little  tenderness  of 
foot  or  ankle  so  often  as  if  he  only  walks. 

Gouty  persons  suffer  frequently  from  relaxed,  sluggish  piles, 
especially  when  travelling.  The  .best  regiminal  treatment  for 
them  is  to  take  some  cayenne  pepper  with  food  as  an  astringent  to 
the  mucous  membrane  of  the  rectum,  and  to  not  only  wash  the 
external  orifice,  but  to  dash  quite  cold  water  against  it  till  a  glow 
of  reaction  is  felt  in  the  bowels,  every  time  after  the  bowels  have 
been  opened.  A  full  supply  of  green  vegetables  in  the  dietary 
should  be  secured. 

I  cannot  recommend  that  the  malaise  which  gouty  persons  often 
feel  for  a  considerable  period,  no  better  and  no  worse,  should  be 
put  an  end  to  by  a  debauch  productive  of  an  acute  attack.  It 
possibly  may  hasten  the  advent  of  the  attack,  but  there  is  no 
proof  of  its  bringing  the  end  of  it  any  nearer.  Whereas  other 
treatment,  which  it  is  not  the  place  to  discuss  here,  accomplishes 
both  objects,  and  gives  a  chance  of  escape  altogether. 

Timid  sufferers  will  sometimes  demand  spirits  "  to  keep  the 
gout  out  of  the  stomach,"  as  they  say.  Now  real  gouty  gastritis 
is  a  very  terrible  malady.  I  had  once  the  opportunity  of  examin- 
ing the  stomach  of  a  debauchee  who  died  of  it,  and  found  the 
mucous  membrane  in  a  state  exactly  resembling  that  produced  by 
oxalic  acid.  This,  however  much  to  be  dreaded,  is  not  likely  to 
be  kept  off  by  alcohol.  But  in  point  of  fact  such  affections  of  the 


GOUT    AND    RHEUMATISM.  269 

stomach  are  very  rare,  and  when  they  do  occur,  do  not  appear  to 
be  retrocedent,  or  to  arise  from  repulsion  of  the  external  inflam- 
mation into  the  viscera,  but  to  bean  extension  of  the  morbid  pro- 
cess, and  to  bear  the  same  relation  to  gout  that  pericarditis  bears 
to  rheumatic  fever.  So  that  one  does  not  see  how  anything  but 
harm  can  be  done  by  alcohol. 

In  spite  of  its  rarity,  it  is  curious  how  much  patients  talk  about  A 
"  gout  in  the  stomach."     I  have  often  thought  that  medical  men  / 
must  have  called  by  that  name  attacks  of  acute  dyspepsia  from 
indigestible  food,  or  of  windy  spasms,  or  of  gastric  neuralgia. 
These  last  are  likely  enough  to  happen  to  the  gouty,  but  diifer 
nowise  in  their  requirements  from  the  same  ailments  occurring  in 
others. 

The  regimen  of  RHEUMATIC  GOUT  does  not  vary  except  in  the 
details,  which  must  be  suited  to  each  individual  case,  from  that 
of  Gout, 

CHRONIC  RHEUMATISM,  or  the  rheumatics,  seldom  need  lay  a  ; 
patient  up,  if  he  will  adopt  the  simple  dietetic  expedient  of  eating 
a  certain  quantity  of  fresh  mustard  with  every  meal,  much- if  he 
is  worse  than  usual,  a  little  if  he  is  pretty  comfortable.  He 
should  avoid  bathing  in  cold  water,  which  will  tend  to  derange 
his  digestion. 

We  must,  however,  carefully  make  the  diagnosis  in  each  in- 
stance between  chronic  rheumatism,  which  is  a  disease  of  the 
fibrous  tissues,'and  neuralgic  pains,  which  run  along  the  lines  of 
the  nerves.  The  latter  are  not  unfrequently  benefited  by  cold 
water,  and  are  aggravated  by  warmth,  especially  by  a  hot  bed. 
Medicinal  treatment  is  here  essential. 


270  DIETETICS    IN    SICKNESS. 


CHAPTER   V. 

GRAVEL,  STONE,  ALBUMINURIA,  AND   DIABETES. 

URINARY  DISEASES  form  a  separate  class  for  the  consideration 
of  the  dietician,  because  in  them  we  have  to  keep  in  mind  not 
only  what  is  likely  to  affect  the  general  health,  but  also  what  will 
affect  the  kidneys  and  bladder  specially,  by  producing  a  secretion 
capable  of  exercising  a  locally  deleterious  action. 

Uric  acid  forms  the  nucleus  of  the  great  majority  of  urinary 
concretions,  and  many  entirely  consist  of  it.  The  small  red  grains, 
like  cayenne  pepper,  and  the  brown  lumps  of  gravel  or  stone,  are 
all  of  considerable  hardness  and  of  smooth  exteriors,  so  that  their 
presence  is  often  unfelt,  till  they  make  themselves  evident,  either 
by  passing  out  into  daylight,  or  by  concreting  together  and  be- 
coming large  enough  to  be  a  mechanical  impediment.  The  great 
object  in  treatment  must  be  to  prevent  the  deposit  of  uric  acid  in 
the  renal  secretion ;  and  when  the  tendency  to  it  is  once  proved, 
not  to  await  the  advent  of  symptoms,  which  only  arise  at  late 
periods  of  the  disease. 

Uric  acid  is  deposited  only  when  it  is  in  excess.  Excess  of 
uric  acid  in  the  system  is,  if  not  absolutely  identical,  at  all  events 
closely  related  to  the  diathesis  of  gout.  So  that  all  that  has  been 
said  about  the  regimen  of  that  disease  may  be  applied  without 
any  reservation  to  this  contingency  also.  The  strict  observance 
of  it  is  the  more  urgent  in  the  degree  that  stone  is  the  more  pain- 
ful and  dangerous  of  the  two. 

Oxalate  of  lime  is  a  substance  whose  very  presence  in  the  urine 
is  decidedly  abnormal  and  morbid.  It  may  be  derived  by  occa- 
sional accident  from  some  article  of  food,  such  as  tomatoes,  or 
rhubarb,  or  sorrel,  without  inconvenience  accruing ;  but  when  not 
to  be  accounted  for  in  this  way,  it  evidences  a  departure  from 
health,  and  the  persistence  of  its  deposit  leads  to  a  most  painful 
form  of  stone.  Its  shape  is  sharp-pointed  crystals,  and  these 
grow  together  into  knobby  masses,  which,  whether  from  their 


GRAVEL    AND    STONE.  271 

form  or  other  unexplained  causes,  give  rise  to  great  agony  in  the 
parts  they  come  into  contact  with.  It  is  of  great  moment,  there- 
fore, to  detect  its  existence  in  the  urine  at  an  early  date,  so  as  to 
anticipate  the  evil  results. 

Oxalate  of  lime  is  often  found  in  children  who  live  in  the 
country  and  have  been  under-fed.  In  this  case  it  would  appear 
to  arise  from  their  eating  an  excess  of  acid  fruits  and  bad  vegeta- 
bles, and  drinking  hard  unboiled  water.  Chemists  tell  us  that 
citric,  malic,  and  other  organic  acids  distributed  through  the  vege- 
table world,  are  liable  to  conversion  into  oxalic;  so  that  it  is  not 
necessary  that  it  should  be  naturally  a  constituent  of  the  food 
eaten,  but  may  arise  during  its  fermentation  or  digestion. 

It  also  is  formed  in  the  urine  of  adults  in  consequence  of  ex- 
posure to  damp  cold,  deficiency  of  fresh  air,  and  a  low  monotonous 
diet.  The  debility  arising  from  frequent  attacks  of  gout  also  in- 
duces the  formation,  so  that  it  appears  mingled  with  urate  of  am- 
monia or  soda,  easily  distinguishable  from  that  amorphous  deposit 
by  the  pointed  octahedral  shape  of  the  crystals  under  the  micro- 
scope. The  persons  in  whom  I  have  found  oxalate  of  lime  have 
been  of  a  nervous  sensitive  constitution,  and  those  of  the  male 
sex  have  frequently  suffered  from  nocturnal  seminal  emissions. 
They  always  feel  much  the  irritation  of  the  neck  of  the  bladder 
induced  by  the  morbid  urine. 

The  indication  afforded  by  the  formation  of  oxalate  of  lime  is 
to  secure  a  generous  animal  diet,  warm  clothing,  fresh  air,  gentle 
exercise  and  rest ;  but,  above  all,  that  repose  of  mind  the  want  of 
which  is  a  prominent  cause  of  the  indigestion.  Rhubarb,  sorrel, 
apples,  pears,  and  in  short  any  raw  fruit  and  vegetables,  should 
be  avoided.  Water-cresses  and  lettuce  are  the  least  objectionable, 
as  they  are  sedative  to  the  urinary  organs  and  prevent  a  scorbutic 
condition  of  the  blood.  A  small  quantity  of  old  spirits  and 
water  at  meals  does  not  in  general  disagree. 

Phosphatic  salts  are  a  natural  ingredient  in  the  urine.  The 
healthier  a  man  is  the  more  of  them  does  he  excrete.  In  the 
normal  condition  of  acidity  of  the  urine  they  are  quite  dissolved. 
But  when  from  the  irritating  presence  of  a  foreign  body,  such  as 
a  uric  acid  calculus  for  instance,  the  surface  of  the  mucous  mem- 
brane of  the  urinary  apparatus  becomes  so  alkaline  that  it  makes 
the  water  alkaline  also,  then  the  phosphatic  salts  are  concreted 


272  DIETETICS    IN    SICKNESS. 

into  crystals  and  solid  masses.  Thus  the  uric  acid  calculus,  or 
other  foreign  body,  becomes  coated  with  a  layer  of  a  nature  quite 
different  from  its  own.  Idiopathic  or  constitutional  inflammation 
of  the  bladder  and  kidneys  may  also  deprive  the  urine  of  its 
healthy  acidity,  and  cause  phosphatic  gravel  to  concrete  without 
any  visible  nucleus  to  concrete  upon.  But  I  cannot  say  I  have 
seen  the  same  happen  from  the  temporary  alkalinity  dependent  on 
taking  soda,  magnesia,  or  potash  in  the  medicine  or  diet.  How- 
ever, where  there  is  a  fear  of  this  result,  in  case  of  an  alkali  being 
required,  it  is  wise  to  use  the  more  diifusible  one,  ammonia. 

The  treatment  of  the  morbid  condition  here  alluded  to  is  wholly 
surgical.  The  mechanical  removal  of  the  cause  of  irritation  is 
imperative  where  it  is  possible.  Where  it  is  impossible,  the  spe- 
cial treatment  of  the  local  inflammation  causing  it  is  the  only  ra- 
tional procedure. 

Gravel  formed  of  the  strange  greenish  substance  called  "  Gystin" 
is  very  rare.  I  have  met  with  only  one  person  who  has  ever 
passed  it,  and  he  seems  to  be  nowise  deteriorated  in  health.  From 
the  large  quantity  of  sulphur  it  contains  (26  per  cent.)  it  would 
seem  to  be  formed  by  the  decomposition  of  some  animal  matter, 
perhaps  solidified  mucus. 

Chronic  Albuminuria,  or  Bright's  disease  of  the  kidneys,  is  a 
complex  state,  the  complication  of  which  involves  several  condi- 
tions with  separate  bearings  on  the  choice  of  the  most  appropriate 
diet  and  regimen. 

The  essential  feature  in  Bright's  disease  is  an  imperfect  nutri- 
tion of  the  smaller  bloodvessels,  by  reason  of  which  they  lose 
their  elasticity  and  tone,  become  thick  and  friable,  are  obstructed, 
and  are  unable  to  supply  the  glandular  structure  of  the  kidney 
with  the  blood  for  depuration.  Hence  a  retention  of  the  urea 
which  should  be  cleansed  out  from  the  circulating  blood.  The 
blood  thus  fouled  fails  to  absorb  sufficient  oxygen,  is  imperfectly 
aerated,  and  cannot  renew  its  red  particles.  Hence,  with  the  re- 
tention of  urea  there  is  anaemia  also.  By  the  force  of  the  heart 
the  fluid  is  still  driven  along,  but  it  meets  obstruction,  instead  of 
help,  in  its  course  from  the  action  of  the  capillaries ;  and  there 
ensues  an  exudation  of  the  easiest  exuded,  that  is  the  serous,  part 
of  its  substance  into  the  nearest  open  space.  Hence  the  urine,  at 


ALBUMINURIA.  273 

the  same  time  that  it  lacks  the  urea  which  it  ought  to  carry  away, 
is  loaded  with  albumen  abnormally  abstracted  from  the  circula- 
tion. 

The  object  aimed  at  by  the  dietician  should  be  to  supply  the 
nutrient  organs  with  aliment  which  is  the  most  readily  and  rapidly 
convertible  into  blood  and  tissue,  namely,  digestible  animal  food 
in  frequent  moderate  quantities.  He  will  also  feed  the  anaemic 
blood  with  iron,  and  in  his  use  of  drugs  will  choose  such  as  con- 
tribute to  rectify  the  deficiencies  of  the  digestion.  Bearing  in 
mind  the  fouling  of  the  blood  with  effete  matters,  he  will  advise 
a  copious  use  of  aqueous  drinks,  which  flow  out  readily  by  the 
kidneys,  carrying  with  them  such  constituents  of  the  diseased 
body  as  are  soluble  in  water.  Especially  will  he  carefully  dis- 
abu^e  the  mind  of  his  patient  of  the  notion  that  drinking  water 
leads  to  dropsy,  and  that  the  thirst  should  be  thwarted  on  this 
ground.  The  warning  is  very  necessary ;  for  an  albuminuriac 
hardly  ever  escapes  at  least  some  subcutaneous  collection  of  fluid 
in  the  face  or  legs  ;  and  if  his  doctor  has  previously  been  urging 
on  him  the  use  of  diluents,  he  accuses  them  of  having  caused  the 
symptom.  In  point  of  fact  the  best  and  only  thoroughly  safe 
diuretic  for  the  relief  of  albuminurious  dropsy,  is  water,  and  it  is 
also  a  valuable  preventive. 

In  disease  of  the  structure  of  the  kidneys,  and  especially  in  al- 
buminuria,  it  is  obvious  that  harm  must  be  done  by  alcohol. 
There  is  no  thoroughfare  through  the  kidneys  for  the  natural 
amount  of  urea  and  phosphates,  still  less  for  the  alcohol.  Thus 
the  ordinary  safety-valve  is  shut  up.  In  this  condition  coma  is 
often  brought  on  prematurely  by  neglect  of  the  warning  voice  of 
the  sensations.  Albuminuriacs  will  always  remark  that  they  feel 
stupid  and  sleepy  after  their  accustomed  amount  of  wine,  and  this 
should  be  a  hint  to  their  medical  attendant  to  leave  it  off,  instead 
of  encouraging  them  to  persist  on  the  plea  of  weakness,  as  is  often 
done. 

An  additional  reason  in  behalf  of  abstinence  is  that  albuminit- 
ria,  at  least  in  its  chronic  form,  indicates  a  degenerative  diathesis, 
which  has  been  already  pointed  out  as  one  of  the  bad  influences 
upon  health  of  alcohol.  Whether  alcohol  or  cold  be  the  sharper 
blade  of  the  shears  so  apt  to  cut  short  life's  thread  by  Blight's 
disease,  I  care  not  greatly,  inasmuch  as  it  cannot  be  questioned 

18 


274  DIETETICS    IN    SICKNESS. 

that  both  of  them  have  that  tendency.  It  is  their  union  which  is 
so  irresistible  a  foe  to  the  poorer  working  classes  who  come  to 
hospitals,  and  it  is  the  avoidance  of  that  union  which  protracts 
the  lives  of  our  wealthy  patients.  I  cannot  repent  of  including 
albuminuria  with  its  attendant  evils  among  the  diseases  caused  by 
alcohol,  and  I  very  much  object  to  the  gin  and  whisky  punch,  the 
hot  grogs  and  the  spirituous  diuretics  which  I  have  known  albu- 
minuriacs  advised  to  drink.  If  they  must  have  the  liquors,  let 
them  at  any  rate  indulge  in  an  occasional  bout  and  be  done  with 
it,  and  not  consume  their  poison  in  its  most  fatal  form  of  small  re- 
peated doses.  Warm  diluents  are  just  as  good  diuretics  without 
alcohol  as  with  it. 

There  is  considerable  difficulty  in  persuading  albuminuriacs  to 
persist  in  a  systematic  milk  diet ;  but  if  it  could  be  managed,  I 
am  persuaded  nothing  would  give  a  better  chance  of  putting  a 
stop  to  the  progress  of  the  lesion. 

In  Diabetes  certainly  life  is  prolonged,  and  the  risk  of  the  in- 
tercurrent  maladies  diminished,  by  a  diet  from  which  sugar  and 
articles  which  form  sugar  are,  as  far  as  practicable,  excluded. 

M.  Bouchardat,  Professor  of  Hygiene  at  the  University  of  Paris, 
gives  the  following  list  of  eatables  whose  chemical  composition 
makes  them  injurious  to  diabetics  : 

Sugar ; 

Bread  of  any  kind,  or  pastry ; 

Rice,  maize,  and  other  starchy  grains ; 

Potatoes,  arrowroot,  tapioca,  among  root  products ; 

Sago,  among  piths ; 

Among  manufactured  starches,  macaroni,  vermicelli,  and  semo- 
lina; 

Of  vegetable  seeds,  peas  and  beans  of  all  sorts,  and  chestnuts ; 

Radishes,  turnips,  beetroot,  carrots ; 

All  preserved  fruits,  apples,  and  pears ; 

Honey,  milk,  beer,  cider,  sweet  and  sparkling  wines,  lemonades, 
and  such-like  sweetened  acid  drinks. 

Happily  the  list  of  permissible  articles  of  diet  is  somewhat 
longer,  and  might  easily  be  extended  by  the  introduction  of  nutri- 
tious eatables  kept  out  of  European  markets  by  want  of  demand. 
The  diabetic  may  eat  without  fear — 

Meat  of  all  kinds,  brown  or  white,  boiled,  roast,  or  grilled,  and 


DIABETES.  275 

seasoned  with  any  sauce  pleasing  to  the  palate,  provided  there  be 
no  flour  or  sugar  in  it ; 

To  the  curious  gourmet,  affected  with  diabetes,  it  may  be  men- 
tioned that  Professor  Bouchardat  especially  commends  the  flesh  of 
carnivorous  animals,  and  advises  their  trying  cat,  dog,  and  fox. 
Probably  larks,  robins,  and  ducks  will  be  more  to  their  taste. 
The  liver,  however,  should  not  be  eaten,  and  by  removing  the  fat 
a  great  deal  of  the  rank  flavor  of  the  carnivora  is  avoided; 

All  sorts  offish,  shell-fish,  and  lobsters; 

Eggs; 

Cream  and  cheese ; 

Spinach,  endive,  lettuce,  sorrel,  asparagus,  hop-tops,  artichokes, 
French  beans,  Brussels  sprouts,  cabbage  (the  last  "  very  good  with 
pickled  pork  or  bacon,"  says  the  good-natured  professor) ; 

Salads  of  cress,  endive,  American  cress,  corn  salad,  dandelion, 
lettuce,  with  a  full  allowance  of  oil  and  hard-boiled  eggs; 

Fresh  vegetable  gluten,  i.  e.,  dough  with  the  starch  washed  out, 
may  be  made  into  an  agreeable  dish  with  grated  Parmesan  or 
Gruyere  cheese  and  butter ; 

Anchovy  and  Ravigote  butter  (see  Gouffe) ; 

For  dessert,  olives.  On  high  days  and  holidays,  when  the  pa- 
tient has  begun  to  improve,  some  fresh  summer  fruit,  of  course 
without  sugar. 

The  wearing  hunger  may  be  much  appeased  by  chewing  cocoa 
beans. 

For  drink,  a  bottle  and  a  half  of  good  claret  or  Burgundy  may 
be  taken  in  the  day.  Those  who  prefer  it  may  take  instead 
brand}-  and  soda-water,  one  part  of  the  former  to  nine  of  the  lat- 
ter. Fresh  beef  tea  is  a  capital  quencher  of  thirst. 

Coffee  with  cream.1 

It  may  be  observed  that  several  of  these  last-named  victuals  are 
not  entirely  devoid  of  sugar,  starch,  or  inosite ;  but  the  quantity 
is  so  small  that  they  may  be  conceded  as  a  variety,  and  are  not 
considered  dangerous  by  our  chief  authority  on  the  subject  who 
has  been  here  quoted.  The  menu  has  not  been  improved  by  any 
of  the  subsequent  writers  on  the  subject,  whose  efforts  have  been 
mainly  directed  to  the  pharmaceutical  treatment  of  the  disease. 


1  Bouchardat,  Du  Diabete  suerg,  Paris,  1852. 


276  DIETETICS    IN    SICKNESS. 

Diabetic  patients  should  always  chew  slowly,  eat  often  but 
moderately ;  and  drink  should  be  taken  in  the  same  fashion. 

They  will  assist  digestion  much  by  wearing  a  flannel  belt  round 
their  waist  next  the  skin. 

They  should  take  a  great  deal  of  gentle  exercise  in  the  open  air. 

The  digestion  will  also  be  improved  by  quinine  and  strychnine, 
to  which  may  be  added,  with  the  approbation  of  the  dietician,  cod- 
liver  oil.  The  action  of  soda,  also,  in  augmenting  the  secretion 
of  gastric  juice,  may  be  brought  into  play  by  the  dietetic  employ- 
ment of  Vichy  water. 

Among  the  substances  forbidden  to  diabetics,  is  unhappily  in- 
cluded that  which  is  proverbially  the  one  thing  needful,  "the  staff 
of  life."  Bread  is  the  article  of  diet  most  prominently  starchy 
and  deleterious,  and  at  the  same  time  the  most  difficult  to  deny. 
To  get  over  this  difficulty,  M.  Bouchardat  devised  a  sort  of  sham 
bread  made  of  gluten.  But  it  is  agreeable  neither  to  the  eye  nor 
to  the  taste,  and  the  patients  on  whom  I  have  tried  it  have  pre- 
ferred going  without  bread  altogether.1  A  much  more  palatable 
substitute  is  proposed  by  Dr.  Pavy  in  his  well-known  work  on 
Diabetes — namely,  cake  made  of  powdered  almonds  and  eggs. 

However,  my  own  opinion  is  that  we  do  not  act  wisely  in  en- 
forcing a  diet  which  is  really  intolerable  to  the  patient.  The  ob- 
ject to  be  gained  is  to  conciliate  the  stomach,  appetite,  and  fancy 
into  taking  the  greatest  possible  amount  of  animal  food  and  olea- 
ginous matter — in  fact,  to  assimilate  the  patient,  as  much  as  pos- 
sible, to  the  Esquimaux  and  Pampas  Indians,  who  have  nothing 
but  water  and  beef,  beef  and  water,  from  the  cradle  to  the  grave. 
And  if  he  eats  the  heartier  for  having  a  biscuit,  or  crust,  or  glass 
of  porter,  or  even  a  forbidden  vegetable  with  his  meals,  it  is  better 
to  give  him  his  way  than  to  tempt  him  to  break  through  all  rules 
altogether  by  playing  the  tyrant. 

There  is  a  doubt  felt  how  far  the  patient's  unnatural  thirst 
ought  to  be  gratified.  Abstinence  diminishes  the  quantity  of 
urine  of  course.  But  is  that  an  advantage?  It  would  seem  bet- 
ter, if  the  blood  gets  loaded  with  sugar,  as  analysis  proves  it  to 
be,  for  the  foreign  ingredient  to  be  washed  out  by  an  ample  out- 
flow, than  for  it  to  remain  at  the  risk  of  poisoning  the  tissues.  It 

1  Lectures  Chiefly  Clinical,  lect.  xxxviii. 


DIABETES.  277 

will  be  found  that  the  thirst  is  closely  proportioned  to  the  amount 
of  sugar  requiring  expulsion.  When  the  diet  is  changed  from 
starchy  to  meaty  food,  much  less  is  drunk,  and  much  less  evacu- 
ated by  the  kidneys,  although  no  restriction  has  been  laid  upon 
the  appetite  for  liquids.  I  do  not,  therefore,  check  patients  in 
drinking  as  much  diluent  as  they  wish. 

In  all  diseases  which  affect  the  mucous  membrane  of  the  uri- 
nary apparatus,  such  as  the  irritation  of  a  stone  in  the  kidneys, 
ureter,  or  bladder,  an  enlarged  prostate,  gonorrhoea,  etc.,  malt 
liquors  are  peculiarly  deleterious.  They  increase  the  secretion  of 
pus,  and  often  bring  it  back  again  when  it  has  stopped  for  several 
days.  This  is  not  to  be  accounted  for  by  the  alcohol  therein  con- 
tained, since  neither  weak  spirits  and  water  nor  sound  claret  has 
the  same  effect ;  but  it  must  arise  from  some  peculiar  condition  of 
the  transformed  malt  forming  an  irritating  ingredient  in  the 
water. 


278  DIETETICS    IN    SICKNESS. 


CHAPTER  VI. 

DEFICIENT   EVACUATION. 

COSTIVENESS  must  be  regarded  as  a  disorder  of  the  whole 
system,  and  not  of  the  intestinal  canal  alone.  The  first  object  of 
treatment  should  be  to  relieve  the  body  of  the  presence  of  excre- 
mentitious  matter,  the  predominance  of  which  in  the  blood  is 
shown  by  the  dingy,  feculent  tint  of  the  complexion,  the  sluggish 
thoughts,  the  headache,  and  the  slow  circulation.  Purgatives, 
then,  may  judiciously  be  used  to  commence  with ;  for  the  imme- 
diate relief  they  afford  to  the  feelings  of  discomfort  is  great.  But 
let  not  the  relief  be  set  down  to  the  mere  "  clearing  out  the  bowels ;" 
it  is  the  cleansing  of  the  blood  which  is  the  real  aim  of  the  remedy, 
and  the  real  cause  of  the  relief.  An  inspection  of  what  comes 
away  shows  that  it  has  been  newly  made  ;  it  is  fresh  bile  and  other 
constituents  of  recent  faces,  not  of  those  which  have  rested  long 
in  the  canal. 

Nothing  is  easier  than  thus  with  a  vigorous  pill  and  draught  to 
drive  away,  as  by  a  charm,  the  patient's  discomforts ;  and  he  is 
ready  enough  to  cry  out  that  no  more  is  wanted.  But  what  is  the 
consequence  of  leaving  off  treatment  ?  The  renewal  of  the  blood 
and  tissues  not  having  had  time  to  regain  its  original  activity — 
there  not  being  enough  new-made  blood  to  carry  on  vigorous  life 
— the  effete  materials  again  collect,  and  the  disease  takes  a  fresh 
start.  Again  and  again  the  coarse  expedient  is  called  for,  and  at 
last  fails  to  effect  its  object  of  giving  relief. 

To  avoid  this  evil  consequence  it  is  prudent  to  administer 
no  quickly  acting  purgatives  which  completely  empty  the  ab- 
dominal canal,  but  rather  such  as  cause  a  gradual  increase  in  the 
solid  matter  of  the  stools.  Aloes  and  rhubarb  are  the  best  evacua- 
tive;  and  I  find  it  also  beneficial  to  combine  with  the  chosen  drug 
some  resin,  which  acts  as  a  tonic  to  the  mucous  membrane,  and 
prevents  the  exudation  of  serum  and  mucus.  Two  or  three  grains 
of  aloes-and  myrrh-pill,  every  night,  will  in  a  week  produce  all 


DEFICIENT    EVACUATION.  279 

the  good  effect  of  strong  purgation ;  and  it  will  produce  the  good 
permanently  instead  of  merely  for  a  time. 

All  superfluous  food  of  the  sort  that  has  the  property  of  arrest- 
ing evacuation  must  be  left  off.  Wine,  beer,  tea,  and  coffee  must, 
on  this  account,  be  excluded  from  the  dietary ;  and  milk,  cocoa, 
whey,  soda-water,  Seltzer- water,  etc.,  substituted  for  them. 

Water  is  a  very  ready  remedy,  and  certainly  a  very  rational 
one,  when  the  evacuation  by  destructive  assimilation  is  deficient. 
The  experiments  of  Dr.  B5cker  and  of  Dr.  Falck1  show  the  in- 
crease of  interstitial  metamorphosis  by  this  agent  to  be  in  close 
proportion  to  the  quantity  taken  ;  and  all  who  have  heard  or  read 
of  the  agreeable  sensations  of  patients  during  their  submission  to 
the  "  Water-cure "  cannot  question  its  capability  of  removing 
matter  from  the  tissue.  Herein  lies  its  strength ;  for,  as  Dr. 
Bocker  observes,  "the  demand  for  new  tissue,  as  expressed  in  the 
sensation  of  hunger,  keeps  pace  exactly  with  the  extent  of  the 
metamorphosis." 

A  much  less  amount  of  water-drinking  than  is  involved  in  a 
hydropathic  course  will  often  be  of  great  service.  Let  the  patient 
take,  the  first  thing  of  a  morning,  a  tumbler  of  water  made  spicy 
by  a  few  cloves  which  have  been  placed  overnight  in  the  tumbler 
and  had  boiling  water  poured  on  them — a  weak  clove-tea  in  fact. 

Warm  hip-baths  are  also  of  great  service,  and  can  be  borne 
from  the  first  even  by  those  reduced  to  extreme  anaemia  and  life- 
lessness.  Afterwards  a  cold  douche  bath,  administered  by  sitting 
in  warm  water  and  having  a  bucket  of  cold  water  poured  down 
the  spine,  or  squirted  against  the  loins  with  a  garden  syringe,  is 
of  essential  use,  by  actively  promoting  the  life  of  the  skin  and 
capillaries.  Raising  the  specific  gravity  of  the  water  by  the  addi- 
tion of  salt  prevents  the  chill  which  fresh  water  is  apt  to  impart. 

Green  vegetables,  of  which  spinach  is  the  completest  specimen, 
should  be  freely  eaten,  and  summer  fruits.  Porridge  is  an  ex- 
cellent breakfast ;  and  brown  bread,  so  that  it  be  not  new,  is  bene- 
ficial as  supplying  a  good  quantity  of  material  for  the  bowels  to 
act  upon.  Watercresses  and  dandelion  are  useful  eaten  raw,  and 
the  watery  extract  from  the  root  of  the  latter  forms  a  suitable 

1  Zeitschrift  dcr  K.  K.  Gesellschaft  der  Aerzte  zu  "Wicn,  April,  1854,  and 
Vierordt's  Archiv,  i,  p.  150. 


280  DIETETICS    IN    SICKNESS. 

drug  to  assist  the  digestive  organs.  Horace  recommends  lettuces, 
and  with  some  reason.  Both  they  and  spinach  may  be  made  into 
soup. 

Roast  apples  and  stewed  prunes  are  much  better  suited  than 
pastry  as  a  second  course  for  the  patients  we  are  now  considering. 
Stewed  prunes  can  also  be  taken  with  meat.  Figs  can  be  eaten 
either  cold  or  in  a  pudding. 

Bacon,  the  most  soothing  of  fats  to  the  digestive  canal,  eaten 
at  meals,  or  two  teaspoonfuls  of  salad  oil  taken  at  bedtime,  pre- 
vent that  drying  and  hardening  of  the  contents  of  the  bowels 
which  causes  much  of  the  inconvenience,  and  they  also  augment 
the  activity  of  the  liver. 

Red  wines  should  be  avoided  by  the  costive ;  they  cause  piles. 
The  best  of  the  white  sorts  are  Chablis,  Sauterne,  and  Capri. 

A  careful  diagnosis  should  be  made  between  deficient  evacua- 
tion (as  above  described)  from  costiveness,  and  that  which  de- 
pends on  anaemia  or  old  age. 

In  anaemia  there  is  almost  always  joined  with  it  (in  the  female 
sex)  a  deficiency  of  catamenial  discharge.  It  is  scanty,  pale,  or 
even  altogether  absent.  This  is  an  indication  for  the  use  of  iron, 
phosphatic  salts  of  lime,  and  cod-liver  oil.  A  diet  drink  of  cin- 
chona is  especially  useful  in  such  cases. 

Porridge. 

Always  use  the  coarsely  ground  Scotch  oatmeal.  Mix  two 
tablespoonfuls  of  it  with  a  small  teacupful  of  cold  water  till  it  is 
of  uniform  consistence.  Then  pour  in  a  pint  of  boiling  water, 
and  keep  boiling  and  stirring  it  for  forty  minutes.  It  is  then  fit 
to  eat,  but  may  be  kept  simmering  till  wanted,  if  a  little  more 
water  be  added  as  the  other  steams  away.  It  should  be  served 
in  a  soup  plate  quite  hot,  and  cold  milk  added  to  reduce  it  to  an 
eatable  temperature. 

Brown  Bread. 

One  of  the  most  useful  purposes  to  which  to  apply  brown  bread 
is  to  make  it  into  bread  sauce,  in  the  manner  before  mentioned 
for  white  bread.  Mixed  with  tomatoes,  it  makes  a  capital  sauce 
for  costive  persons. 

Brown  bread  biscuits  are  also  eligible. 


DEFICIENT    EVACUATION.  281 

Oatmeal  Flummery. 

Take  crushed  Embden  grits  in  proportion  to  the  quantity  re- 
quired. Put  them  into  a  broad  pan,  cover  with  water,  stir  up 
together,  and  let  stand  for  twelve  hours.  Then  pour  off  the  water 
so  long  as  it  runs  clear.  Add  fresh  water,  mix,  and  let  stand 
twelve  hours  more.  Repeat  the  same  process  a  third  time.  When 
the  oatmeal  has  been  thus  macerated  thirty-six  hours,  strain  it 
through  a  hair  sieve  and  boil  it,  stirring  vigorously  till  it  is  quite 
thick.  Pour  it,  to  cool,  in  a  dish,  and  eat  it  cold  with  milk,  or 
a  little  wine  and  sugar. 

Spinach  Soup. 

Pick  all  the  stalks  from  1J  Ib.  weight  of  fresh  spinach;  wash 
it  and  chop  it;  put  it  in  a  3-quart  stewpan  with  four  ounces  of 
butter;  stir  it  over  the  fire  for  five  minutes;  add  an  ounce  of 
flour  and  stir  again  for  three  or  four  minutes.  Then  stir  in  two 
quarts  of  chicken  broth  till  it  boils.  Simmer  it  on  a  cool  stove 
for  half  an  hour,  and  add  a  small  teaspoonful  of  cream.  Serve 
with  it  some  pulled  bread  fried  or  baked. 

Endive  or  lettuce  soup  may  be  prepared  in  the  same  way. 


Lettuces  with  Gravy 

Take  8  round  and  full  cabbage-lettuces  ;  trim  off  all  the  outside 
leaves  ;  wash  and  blanch  for  10  minutes  ;  cool  them  well  ;  squeeze 
the  water  out  ;  cut  them  in  two  ;  lay  them  open  on  a  dish,  and 
season  them  with  3  pinches  of  salt  ;  tie  the  halves  together,  and 
put  in  a  2-quart  stewpan  ;  cover  them  with  broth  and  add  2  gills 
of  stock  pot  fat,  1  fagot,1  and  1  onion  with  2  cloves  stuck  in  it  ; 
place  a  round  of  paper  on  the  top,  and  simmer  for  2  hours  ;  when 
cooked,  drain  on  a  cloth  :  untie  and  open  the  lettuces  again  ;  cut 
the  stalks  out,  and  fold  the  leaves  round,  giving  to  each  piece  an 
oval  shape,  about  3  inches  by  2  inches,  and  dish  them  in  a  circle. 

Reduce  1J  pint  of  household  gravy  to  half  the  quantity  ;  pour 
it  over  the  lettuces,  and  serve. 

Thin  slices  of  crumb  of  bread,  cut  to  the  shape  of  the  lettuces, 
can  be  put  in  the  intervals  between  the  lettuces. 

1  A  fagot  should  contain  a  small  handful  of  parsley,  a  sprig  of  thyme, 
and  a  bay-leaf.  It  should  be  tied  up  with  string,  so  that  none  of  the  leaves 
break  off  in  cooking.  It  is  a  perfectly  wholesome  seasoning. 


282  DIETETICS    IN    SICKNESS. 


CHAPTER  VII. 
NERVE  DISORDERS. 

§  1.  HYSTERIA. 

IT  has  been  authoritatively  stated  that  "  the  physician  can  do 
but  little  for  one  who  is  born  hysteric ;  i.  e.,  for  one  whose  disease 
is  but  an  exaggeration  of  her  habitual,  constitutional  state."1  I 
cannot  agree  in  that  sentence,  for  I  am  sure  that  a  judicious  medi- 
cal adviser  may  very  often  give,  even  to  such  a  born  suiferer  as 
above  described,  advice  which  will  enable  her  not  only  to  be  com- 
fortable herself,  but  to  be  a  useful  member  of  society.  And  of 
such  advice  one  point  of  dietetic  regimen  will  always  form  a  part 
in  every  single  case — "  Let  no  fermented  or  spirituous  liquid  ever 
cross  your  lips."  I  have  not  a  shadow  of  a  doubt  that  at  least 
one-third  of  the  subjects  of  hereditary  hysteria  we  come  across, 
would  never  have  developed  into  the  declared  disease  had  they  ob- 
served this  abstinence. 

Hysteria  has  already  been  spoken  of,  in  a  chapter  concluding 
the  second  part  of  this  volume,  as  kept  up,  if  not  originally 
started,  by  alcohol.  This  is  most  especially  true  (according  to  my 
observation)  of  those  irregular  chronic  forms  of  the  ailment  where 
there  are  few,  if  any,  stormy  paroxysms  or  convulsions.  I  have 
been  surprised  to  find  how  often  a  total  abstinence  from  fermented 
and  spirituous  liquors  is  followed  by  a  restoration  of  the  invalid's 
strength.  That  incapacity  for  exertion,  which  made  a  witty  hys- 
teriac  say  the  other  day  that  she  should  take  "  Non  possumus  "  as 
her  motto,  vanishes  as  if  by  magic,  and  your  patient  cheerfully 
adopts  all  the  further  means  for  her  cure. 

It  is  not  here  meant  to  be  implied  that  hysteria  in  all  cases,  or 
even  in  any  large  proportion  of  cases,  is  brought  on  by  tippling. 
Such  an  idea  is  quite  negatived  by  the  age  and  social  condition 

1  Keynolds's  System  of  Medicine,  vol.  ii,  p.  325. 


HYSTERIA.  283 

of  most  of  its  victims.  Compared  with  hereditary  and  educa- 
tional influences,  with  mental  depression,  with  starvation,  with 
tea-drinking,  with  pelvic  irritation,  with  dyspepsia,  the  experience 
of  the  ailment  (as  collected  by  M.  Briquet1)  shows  the  evil  power 
of  alcohol  to  be  inconsiderable  in  the  number  it  thus  immediately 
affects.  Still  I  cannot  but  think  that  if  they  had  been  made  from 
clinical  records  in  this  country,  his  statistics  would  have  assigned 
more  importance  to  it  as  an  originating  influence.  What  we  are 
concerned  with  now,  however,  is  its  injurious  action  on  the  disease 
already  established.  Of  that  I  have  no  doubt.  And  I  find  a 
full  explanation  of  the  fact  in  the  innutrition  of  the  nerve  tissue 
which  was  illustrated  by  experiment  in  the  former  chapter  on 
"Alcohol." 

There  is  in  the  treatment  of  hysteria  a  difficulty  of  diagnosis 
which  especially  concerns  the  use  of  alcohol,  namely,  that  arising 
from  the  frequent  occurrence  in  the  same  person,  and  at  the  same 
time  too  very  often,  of  some  variety  of  neuralgia,  such  as  inter- 
mittent tic,  brow  ague,  and  stitch  in  the  side,  which  when  they 
occur  alone  are  benefited  by  high  living  and  port  wine.  A  trim- 
ming treatment  is  necessary  here,  but  if  the  hysteria  predominates, 
I  strongly  object  to  the  employment  of  alcoholic  stimulants. 

The  momentary  relief  afforded  by  the  poison  puts  a  mountain- 
ous difficulty  in  the  path  of  those  who  would  give  their  clients 
advice  grounded  on  the  truths  established  by  science.  We  feel 
ourselves  so  weak,  that  some  have  swallowed  the  fallacies  of  tee- 
totalism,  so  as  to  be  able  to  "answer  a  fool  according  to  his  folly." 
Others  of  us,  to  keep  one  another  up  by  mutual  moral  support, 
banded  together  two  years  ago,  to  sign  a  protest  against  the  misuse 
of  alcohol  in  medicine.  And  I  do  think  that  the  latter  movement 
has  had  considerable  effect  in  rousing  the  consciences  of  medical 
men  to  the  meanness  of  conciliating  patients,  especially  nervous 
patients,  by  allowing  them  to  drown  pain  in  what  is  a  final  poison. 

The  best  way  of  breaking  off  the  habit  of  yielding  to  the  per- 
verted sensation  which  so  insidiously  cries  for  alcohol,  is  immedi- 
ately and  altogether  to  relinquish  it.  Terrible  sometimes  is  the 
struggle,  yet  it  is  a  bracing  and  ennobling  conflict;  whereas  the 
long-continued  daily  annoyance  of  giving  it  up  little  by  little  is 

1  Briquet  sur  1'  Hysterie. 


284  DIETETICS    IN    SICKNESS. 

on  the  whole  quite  as  painful,  and  is  often  enfeebling  to  the  mind. 
Moreover,  courage  is  likelier  to  give  way  in  a  month  than  in  a 
day. 

A  generous  nitrogenous  diet  is  essential  in  the  treatment  of 
hysteria.  Meat  should  be  eaten  at  breakfast,  and  it  will  be  found 
to  be  less  repulsive  and  easier  digested  if  the  internal  viscera  be 
previously  braced  up  by  a  shower  bath,  or  a  cold  douche  to  the 
spine.  The  best  drink  is  milk  and  soda  water,  in  the  proportion 
of  about  half  of  each. 

The  hysteric  temperament  will  in  the  female  sex  sometimes 
cause  functional  derangement  of  the  periodical  evacuation,  either 
in  excess,  defect,  or  painfulness.  As  a  rule,  all  local  treatment  is 
to  be  avoided,  and  the  attention  of  the  patient  withdrawn  from 
what  is,  in  point  of  fact,  a  mere  accidental  symptom  to  a  due 
regulation  of  the  diet  and  regimen.  And  the  same  rule  will  ap- 
ply to  irritation  of  the  urinary  organs. 

Pottutio  nocturna  in  men  also  often  arises  from  the  same  cause. 
Excluding  the  cases  where  this  annoyance  depends  on  worms  or 
piles  in  the  rectum,  it  will  be  found  that  nine-tenths  of  the  sub- 
jects of  it  come  of  hysterical  families,  and  may  be  relieved  by 
anti-hysteric  treatment.  If  it  is  associated  with  impotentia  coram 
foemina,  the  diagnosis  of  the  temperament  is  the  more  easy.  Here 
again  local  interference  is  most  pernicious. 

§  2.  DELIRIUM  TREMENS,  ALCOHOLISM. 

Nobody  but  a  whimsical  doctrinaire  would  propose  to  relieve 
physical  phenomena  really  similar  in  essential  matters  to  such  as 
are  caused  through  a  drug,  by  administering  an  additional  similar 
stimulant.  No  man  of  plain,  unclouded  common  sense  does  so  in 
words ;  but  in  act,  the  vulgar  drunkard  looks  upon  himself  as 
performing  a  feat  of  wisdom,  when  he  takes  "  a  hair  of  the  dog 
that  bit  him."1  What  this  does  (if  it  is  strong  enough  to  do  any- 


Si  nocturna  tibi  noc.eat  potatio  vini, 
Hoc  iu  mane  bibas  iterum,  etfuerit  medicina. 
"If  overnight's  debauch  does  hurtful  prove, 
A  glass  next  morning  will  your  pains  remove." 

Sanctorius. 


ALCOHOLISM.  285 

thing)  is  to  stop  the  painful  process  of  eliminating  the  toxic  agent. 
It  is  equivalent  to  an  attempt  to  soothe  retching  when  a  man  has 
swallowed  an  ounce  of  laudanum.  The  retching  may  be  soothed 
certainly,  and  by  an  additional  dose  of  the  laudanum  itself;  but 
the  sufferer  is  all  the  worse  in  the  end. 

As  a  remedy  for  drunkenness  some  have  employed  the  agency, 
supposed  to  be  antagonistic  to  alcohol,  of  sulphuric  ether.  It  has 
been  useful  in  dead-drunkenness  (coma),  and  those  who  have  in- 
dulged in  secret  will  sometimes  steady  themselves  and  cover  the 
airy  evidence  of  their  brandy  dram  with  an  odor  which  hopes  to 
pass  as  an  article  of  materia  medica.  I  suspect  the  proceeding 
differs  in  nowise  from  that  above-named.  The  safest  and  quickest, 
though  not  the  pleasantest,  cures  for  the  remorse  of  a  guilty 
stomach,  are  patience  and  diluents.  Let  the  sick  man,  if  he  still 
on  principle  adheres  to  his  "  hair,"  make  it  as  little  a  one  as  pos- 
sible, and  drowned,  as  completely  as  possible,  in  the  antagonistic 
fluid,  water;  and  let  the  patience  be  seasoned  with  repentance; 
and  then  he  may  calculate  safely  on  being  no  worse  in  the  end  for 
his  temporary  folly.  In  this  case  what  happens,  probably,  is  a 
retention  of  effete  matters,  especially  in  the  nervous  tissue,  pro- 
portionally greater  than  that  noted  in  Experiments  I,  II,  and: 
III,1  in  the  ratio  of  the  amount  of  alcohol  held  in  the  body  at 
once — a  retention  followed  by  a  copious  evacuation,  not  only  of 
the  retained  matters,  but  of  the  results  of  an  increase  in  destruc- 
tive assimilation.  Hence  a  feeling,  not  of  satisfaction,  as  when 
retained  effete  matters  are  got  rid  of  by  a  timely  purge,  but  of 
painful  exhaustion.  The  body  is  actually  lighter,  as  noticed  by 
Sanctorius,  but,  from  weariness,  feels  heavier.  After  the  evacua- 
tion has  gradually  ceased,  there  is  no  reason  to  doubt  that  the 
body  quite  recovers  itself,  for  temporary  functional  disturbances, 
when  time  is  allowed  for  full  completion  of  the  crisis,  leave  no 
organic  traces. 

So  that  the  occasional  (say  "  monthly  "  in  deference  to  Sanctor- 
ius) drunkard,  if  he  also  takes  a  monthly  bout  of  penitence  and 
temperance,  probably  does  not  shorten  his  days.  But  that  he 
thereby  lengthens  them  or  gladdens  them,  implies  a  condition  of 
things  that  never  need  voluntarily  be  submitted  to  in  Europe. 

1  See  puges  200,  206,  208. 


286  DIETETICS    IN    SICKNESS. 

It  implies  a  monotony  of  surroundings  which  will  thank  a  misery 
for  a  change,  and  clock-like  habits  unbroken  by  the  due  mental 
and  bodily  stimulants  of  natural  life.  It  implies  an  existence  ap- 
proaching to  that  of  the  Pitcairn  Islanders,  the  descendants  of  the 
crew  of  the  "  Bounty,"  who  are  described  by  their  rare  visitors  as 
having  eliminated  from  their  little  community  all  that  could  lead 
to  sorrow  or  irregularity,  without  diseases  and  without  doctors ; 
and  yet  they  rapidly  grow  old,  and  soon  after  forty  are  calmly 
gathered  to  their  forefathers,  simply  because  they  have  nothing 
else  to  do.  Their  last  sexagenarians  were  some  survivors  of  the 
original  mutineers.  This  is  an  extreme  case,  but  we  sometimes 
come  across  examples  of  too  monotonous  an  existence  even  in 
civilized  life,  as,  for  instance,  in  the  families  of  respectable  persons, 
engaged  in  safe  trade.  Amusement  and  ambition,  from  want  of 
use,  fail  to  attract  them,  and  considerable  ingenuity  is  often  re- 
quired to  make  them  care  for  anything.  Dramatic  entertainments, 
either  on  stage,  platform,  or  pulpit,  afford  the  readiest  resource ; 
but  of  course  any  hobby  in  which  the  patient  may  himself  act  a 
part,  is  much  more  valuable.  All  these  are  much  healthier  stimu- 
lants than  alcohol ;  and  moreover,  whatever  sanatory  merits  in- 
toxication might  have,  the  moral  objections  to  it  would  outweigh 
them  all,  and  in  spite  of  the  authority  of  Sanctorius  and  our  grat- 
itude to  him  as  a  physiologist,  I  hope  I  shall  never  again  hear 
any  one  advised  to  get  drunk  for  the  good  of  his  health. 

Delirium  Ebrietatis,  "  mad  drunkenness,"  is  the  systematic  name 
given  to  a  form  of  intoxication,  whose  peculiarity  depends  on  the 
diathesis  or  temperament  of  the  sufferer's  brain.  While  most 
grow  stupid,  quarrelsome,  or  maudlin  under  drink,  some  (with 
probably  a  latent  taint  of  insanity  in  them)  have  a  dangerous  ten- 
dency to  grow  furious,  and  to  have  delusions  which  still  further 
excite  their  fury.  The  affection  is,  in  fact,  a  sort  of  mania,  ex- 
hibited only  during  the  presence  of  alcohol  in  the  blood.  Indeed, 
in  Dr.  Darwin's  days,  it  was  apparently  considered  true  mania ; 
and  as  bleeding  was  usual  in  mania  then,  it  was  practiced  for 
delirium  ebrietatis  also,  though  not  with  the  approbation  of  that 
far-sighted  physician,  who,  in  this  and  many  other  things,  was 
much  in  advance  of  his  generation.  He  says,  "  Venesection,  I 
believe,  sometimes  destroys  those  who  would  otherwise  have  re- 


ALCOHOLISM.  287 

covered  in  a  few  hours."1  He  recommends  emetics  and  watery 
liquids,  which  are  antagonistic  to  alcohol,  and  therefore  I  presume 
he  would  join  me  in  classing  this  among  the  diseases  where  alco- 
hol is  to  be  avoided.  It  is  important  to  distinguish  it  from  mad- 
ness, in  which  alcohol  is  sometimes  useful,  as  will  he  afterwards 
noticed.  A  few  hours  will  certify  the  diagnosis,  as  delirium  ebrie- 
tatis  is  soon  recovered  from,  unless  the  patient  be  a  constant 
tippler. 

Delirium  Tremens — or  "the  horrors" — is  the  familiar  and  dis- 
tinct form  of  disease  of  the  nervous  system  arising  from  the  long- 
continued  deleterious  influence  of  alcohol  on  health.  Its  pathology 
has  already  (p.  211,  etc.)  been  assigned  to  an  arrest  of  the  renewal 
of  the  tissues,  especially  those  which  contain  phosphorus — an  arrest 
found  by  experiment  when  even  small  quantities  of  alcohol  are 
ingested,  and  apparently  directly  proportioned  to  the  continuous- 
ness  of  the  ingestion.  It  is  distinct  from  delirium  ebrietatis,  not 
only  in  its  symptoms,  which  are  too  well  known  to  need  repeti- 
tion, but  in  the  fact  that  these  symptoms  seldom,  if  ever,  follow 
immediately  on  an  unusual  excess.  It  is  true  that  a  man  may  be 
mad  drunk,  and  after  a  time  drivel  off  into  the  horrors,  if  he  is 
an  habitual  dram-drinker;  but  he  does  not,  as  a  rule,  get  struck 
with  the  horrors  during  his  debauch.  Indeed,  this  form  of  dis- 
ease, as  often  as  not,  is  the  consequence  of  a  sudden  omission  of 
the  customary  stimulant.  It  is  on  the  ground  of  this  last-named 
fact,  apparently,  that  some  practitioners  have  thought  it  best  to 
continue  the  use  of  alcohol,  while  the  patient  is  still  raving  and 
trembling  from  its  effects.  I  do  not  understand  them  to  suppose 
that  they  are  acting  on  any  homoeopathic  principle :  they  aim  only 
at  fending  off  the  danger  of  the  excessive  crisis  by  restoring  that 
condition  of  alcoholic  saturation  the  patient  enjoyed  previously, 
and  during  which  he  did  not  fall  into  delirium  tremens.  I  can- 
not agree  with  those  practitioners.  Truly  enough  the  raving,  and 
the  terror,  and  the  trembling,  and  the  sweating,  and  the  awful 
chaos  of  dreaming  and  wakefulness,  in  which  the  poor  wretch  is 
plunged,  are  made  somewhat  more  tolerable  by  the  dose — the 
pains  are  palliated.  Nevertheless,  there  is  a  higher  aim  of  treat- 
ment than  palliation  of  pain ;  the  danger  to  life  does  not  depend 


1  Zoonomia,  ii,  1,  7. 


288  DIETETICS    IN    SICKNESS. 

on  these  symptoms,  but  on  the  suspension  of  the  controlling  func- 
tions of  the  brain ;  and  to  that  suspension  and  danger  each  addi- 
tional drop  of  alcohol  must  contribute  its  share.  I  feel  sure  that 
life  is  risked  by  the  alcoholic  treatment  of  delirium  tremens ;  and 
the  risk  of  life  is,  in  this  disease  especially,  the  paramount  con- 
sideration. For  the  patient  has  brought  it  on  himself  by  his  own 
fault,  and  so  long  as  he  does  not  die  I  am  very  little  anxious  to 
spare  him  the  pains  and  penalties  of  his  self-indulgence,  which 
pains  and  penalties  may  perhaps  contribute  useful  lessons  of  future 
conduct. 

My  own  plan  of  treatment  has  been  to  cut  off  the  supply  of 
alcohol — at  once,  and,  so  far  as  my  power  extends,  forever.  Where 
there  is  no  vomiting,  I  give  a  mustard  emetic,  and  then  a  purga- 
tive enema.  If  the  patient  is  quiet  enough,  the  vital  temperature, 
which,  as  we  have  seen  (p.  203),  is  lowered  by  alcohol,  should  be 
kept  up  by  a  warm  bath,  or  at  least  by  hot  ablutions.  And  fresh 
material  for  new  tissue,  with  assistance  in  getting  rid  of  effete  tis- 
sue, should  be  assiduously  furnished  in  the  shape  of  meat  and 
water  united,  as  beef  tea  with  the  pounded  beef  in  it.  A  sift  of 
pepsin  mixed  with  grated  Parmesan  cheese  will  make  it  spicy 
for  the  jaded  stomach,  and  promote  its  digestion.  The  addition 
is  especially  desirable  if  in  consequence  of  vomiting  the  food  has 
to  be  taken  by  enema.  (See  recipe  for  the  enema,  p.  242.) 

It  will  be  seen  that  the  intention  of  the  abovementioned  treat- 
ment is  to  evacuate  the  alcohol,  and  to  counteract  its  suspensory 
influence  on  the  vital  warmth  and  on  the  assimilation  and  renewal 
of  the  nervous  tissue. 

There  is  one  other  highly  important  measure  which  is  rendered 
needful  by  the  reduced  power  of  the  nervous  system  during  its 
functional  arrest.  The  functions  that  depend  upon  it  must  be 
spared  work.  Complete  quiet,  and  shielding  from  whatever  can 
excite  the  mind,  is  important,  not  only  during  the  disease  but 
during  convalescence,  lest  a  relapse  should  occur.  The  excitement 
may  be  so  mild  as  scarcely  to  occur  to  us  as  a  risk ;  yet  by  the 
frail  machinery  and  unfed  tissues  it  cannot  be  borne.  I  will 
quote  an  example  from  my  note-book.  An  earnest  young  curate 
who  came  under  my  care  for  delirium  tremens,  contracted  by 
drinking  bad  brandy  to  support  him  in  his  daily  ministration  to 
a  large  country  parish,  had  got  so  well  again  that  I  consented  to 


ALCOHOLISM.  289 

his  breaking  the  intolerable  idleness  of  a  Sunday  in  London,  by 
hearing  a  famous  preacher.  During  the  night  (to  my  shame)  he 
had  a  relapse,  and  acknowledged  that  the  cause  was  the  contagious 
enthusiasm  of  the  orator.  Again,  in  a  former  chapter  (page  212) 
is  mentioned  a  case  strongly  impressed  on  my  memory  by  being 
the  only  young  female  patient  I  have  lost  by  delirium  tremens, 
and  in  which  the  disease  was  due  to  the  mental  excitement  caused 
by  a  false  accusation  of  theft  after  dram-drinking  of  by  no  means 
an  excessive  character.  This  weakness  of  the  nerve  tissue  which 
gives  way  under  such  moderate  pressure  as  it  could  easily  resist 
in  health,  is  explained  by  the  arrest  of  its  vitality  indicated  by 
the  non-excretion  of  phosphates  during  the  after-effects  of  alco- 
holic anaesthesia,  as  before  described.  We  must  not  forget  to 
allow  for  it  in  the  treatment  of  patients. 

It  is  rather  beyond  the  scope  of  the  subject  in  hand  to  speak  of 
the  influence  of  other  anaesthetics  in  disease;  yet  I  cannot  pass  on 
without  saying  that  if  an  ordinary  dose  of  opium  or  its  alkaloids, 
or  of  hydrate  of  chloral,  gives  a  patient  a  few  hours'  sleep,  he 
seems  to  me  none  the  worse  for  it.  But  it  is  most  dangerous  to 
look  upon  them  as  specific,  and  to  administer  them  in  continuous 
reprises  till  sleep  follows,  or  in  the  enormous  doses  that  have  been 
employed  by  some  practitioners.  The  reason  for  those  enormous 
doses  being  tolerated  is  that  absorption  has  been  arrested,  and 
that  they  have  passed  away  harmlessly.  But  supposing  that  ab- 
sorption should  be  suddenly  restored,  the  enormous  dose  can 
hardly  fail  to  cause  sudden  death.  No  advantage  is  gained,  and 
a  great  risk  is  incurred.1 

In  chronic  alcoholism  I  allow  the  same  argument  to  hold  good. 
I  have  never  found  harm  to  arise  from  leaving  off  alcohol  alto- 

1  It  is  surprising  to  find  such  a  generally  judicious  physician  (Dr.  Todd) 
an  advocate  of  the  homoeopathic  treatment  of  alcoholic  poisoning.  In  the  last 
of  his  Clinical  Lectures  on  certain  Acute  Diseases  (one  on  the  therapeutical 
effects  of  alcohol)  he  commends  the  free  administration  of  wine  to  a  child  of 
three  years  old,  who  was  dying  from  convulsions  and  hemiplegia  in  con.->'- 
quence  of  having  swallowed  a  large  quantity  of  gin,  and  regrets  that  brandy 
had  not  also  been  poured  in  by  the  rectum.  He  relates  also  specimens  of  de- 
lirium tremens  similarly  managed,  but  their  result  cannot  be  said  to  justify 
the  use  of  brandy  except  to  a  most  bigoted  adherent.  He  himself  does  not 
propose  to  act  in  the  same  way  in  respect  of  other  articles  of  the  materia 
medica. 

19 


290  DIETETICS    IN    SICKNESS. 

gether  and  at  once.  I  am  not  prepared  to  deny  that  delirium 
tremens  may  have  been  the  result,  in  some  cases,  of  such  precipi- 
tation, but  it  has  not  happened  in  my  experience ;  and  I  should 
be  ready,  if  it  did  happen,  to  treat  it  in  the  usual  way,  confident 
that  the  patient,  in  spite  of  the  accident,  was  still  gaining  a  posi- 
tive advantage  by  abstinence. 

§  3.  AGUE  AND  INTERMITTENTS. 

In  ague,  alcohol  should  not  be  spared  as  an  article  of  diet;  and 
taken  more  freely  than  usual  it  contributes  to  lengthening  the  in- 
terval and  shortening  the  paroxysms,  converting  quotidian  into 
tertian,  and  curing  tertian  altogether.  And,  in  brow-ague,  neu- 
ralgia, inconstant  sciatica,  and  other  intermittent  disease  of  simi- 
lar nature,  it  is  sometimes  equally  efficacious.  But,  given  during 
the  paroxysms,  I  have  not  found  so  much  benefit — perhaps  it  is 
not  absorbed. 

In  ague  the  combination  in  which  alcohol  is  offered  is  of  con- 
siderable importance.  The  most  generous  red  wines  should  be 
used,  and  the  distance  at  which  their  bouquet  may  be  smelt  may 
be  taken  as  a  rough  test  of  their  utility.  I  remember  learning  a 
lesson  on  this  point  from  a  most  unscientific  source.  I  was  chat- 
ting in  the  market-place  at  Dijon  with  a  farmer's  wife,  when  she 
incidentally  mentioned  that  her  husband  was  a  great  sufferer  from 
ague,  and  was  quite  tired  of  swallowing  quinine.  I  advised  her 
to  take  home  a  good  supply  of  Burgundy  in  her  market-basket, 
and  begged  to  contribute  the  few  francs  I  had  in  my  pocket.  She 
tripped  straight  off  to  a  grand  wine-merchant's  office;  but  instead 
of  coming  out  fully  laden,  she  bore  only  two  bottles,  to  the  price 
of  which  she  had  contributed  out  of  her  own  purse.  It  was  of  a 
vintage  such  as  is  allowed  to  trickle  slowly  over  the  tongue  at  the 
table  of  a  prince,  and  I  promptly  called  her  a  prodigal.  "  No,  no," 
said  she,  "  I  am  not ;  a  mouthful  of  this  is  worth  to  a  sick  man  a 
bucket  of  commoner  wine" — and  yet  the  common  wine  of  Dijon 
is  not  to  be  sneered  at.  She  was  quite  right;  there  is  no  wine 
like  Burgundy  for  ague,  and  the  price  (provided  the  merchant  be 
honest)  is  a  direct  measure  of  its  medicinal  value. 


SUNSTROK^!.  291 


§  4.  OTHER  DISEASES  OF  THE  NERVOUS  SYSTEM. 

Alcohol  has  been  used  with  great  advantage  in  Sunstroke.  Dr. 
Maclean  (in  his  article  on  the  subject  in  Reynolds's  "System  of 
Medicine")  strongly  commends  the  employment  of  Warburg's 
Tincture,  the  only  known  ingredient  in  which  is  alcohol,  and  in 
addition  a  judicious  quantity  of  dietetic  stimulants.  The  treat- 
ment advocated  by  this  gentleman  does  not  seem  to  have  yet 
taken  hold  of  the  Anglo-Indian  medical  mind,  for  the  author 
speaks  of  venesection  still  being  employed  on  a  large  and  fatal 
scale  quite  recently;  so  that  numerical  evidence  of  success  cannot 
be  furnished.  I  should  expect  it  when  collected  to  be  decisive; 
for  there  are  reported  in  sunstroke  several  most  important  symp- 
toms which  connect  its  pathology  with  that  of  other  morbid  states 
benefited  by  alcohol,  viz.,  a  copious  excretion  of  solids  in  the 
urine,  a  high  temperature  of  blood,  delirium,  weakness  of  the 
sphincters,  trembling  of  the  muscles,  and  death  by  syncope  or 
coma. 

I  have  never  had  a  case  of  genuine  sunstroke  under  my  care, 
the  best  imitation  of  one  which  this  cloud-kerchiefed  climate  has 
afforded  me  having  been  caused  by  long  sitting  at  a  desk  with  a 
bald  head  close  to  an  Argand  gas  burner.  But  if  ever  I  were  to 
practice  in  a  hot  climate,  I  should  unhesitatingly  adopt  Dr.  Mac- 
lean's treatment,  both  as  to  the  use  of  ice  and  of  alcohol. 

In  concussion  of  the  brain  from  accident,  stimulants  are  usually 
administered  before  the  arrival  of  a  surgeon,  and  no  injurious  con- 
sequences appear  to  follow.  And  blows  on  the  head  which  hap- 
pen to  revellers  produce,  as  a  rule,  much  less  cerebral  lesion  after- 
wards than  is  expected  from  their  violence.  The  hint  should  not 
be  lost,  especially  since  some  of  the  symptoms  of  severe  jar  to  the 
brain-tissue  much  resemble  those  recorded  as  produced  by  sun- 
stroke ;  indeed,  so  closely  as  to  have  suggested  the  insertion  of 
this  paragraph  in  its  present  place. 

Neuralgia  is  often  decidedly  benefited  by  alcohol,  as  has  been 
already  said.  Taken  dietetically  at  meals,  it  involves  no  risk  of 
tempting  the  patient  to  intemperate  indulgence;  and  if  good  gen- 
erous wine  be  the  vehicle,  a  very  moderate  quantity  often  suffices. 


292  DIETETICS    IN    SICKNESS. 

Spirits  are  not  nearly  so  effectual,  and  require  to  be  employed  in 
larger  doses. 

But  this  is  not  all  that  the  sufferer  asks ;  he  wants  to  know  if 
he  may  not  have  recourse  to  the  remedy  when  his  agonies  are 
upon  him ;  for  neuralgia  is  not  like  ague,  and  is  relieved  in  an 
unmistakable  manner  by  alcohol  during  the  paroxysm.  It  is  hard 
to  refuse,  and,  unless  the  patient  surpasses  the  average  in  folly,  I 
do  not  refuse.  But  at  the  same  time  I  give  this -caution — that 
the  intended  dose  should  be  fixed  upon,  and  not  exceeded  even  if 
the  pain  remain  as  severe  as  ever.  The  chief  benefit  is  by  no 
means  immediate,  but  consists  principally  in  shortening  the  par- 
oxysm. An  intimate  friend  of  mine  with  an  "irritable  stump," 
often  brought  on  (like  Nelson's)  by  cold  or  mental  annoyance,  on 
the  invasion  of  the  spasmodic  movements  takes  a  tumbler  of  very 
hot  spiced  port  (bishop)  or  of  stiff  Avhisky  toddy,  and  then  waits 
patiently  till  the  trouble  ceases.  This  it  usually  does  in  two  or 
three,  instead  of  lasting  twenty-four,  hours.  But  whatever  hap- 
pens, he  strongly  advises  that  the  stimulant  should  not  be  re- 
peated. 

Hypoohondriasis  is  too  generally  a  constitutional  and  hereditary 
complaint  to  be  a  good  test  of  the  virtue  of  any  remedy.  The 
few  hypochondriacs  in  whom  I  have  witnessed  any  improvement 
have  been  persons  who  had  been  living  a  dull  abstemious  life,  and 
have  been  persuaded  on  sanatory  grounds  to  indulge  the  palate 
and  the  fancy  from  time  to  time  with  unwonted  liberality.  It  is 
very  possible  that  Sanctorius's  monthly  excess  might  be  a  sanatory 
measure  here,  though  one  is  loath  to  give  advice  which  is  capable 
of  misinterpretation.  But  the  daily  and  habitual  use  of  alcohol 
in  hypochondriasis  is  worse  than  useless — in  fact,  deleterious.  I 
have  known  several  cases  receive  much  benefit  from  entirely  leav- 
ing it  off. 

There  is  a  peculiar  form  of  hypochondriasis  which  arises  from 
eating  too  little  vegetables  and  too  much  meat.  It  is  distinguished 
by  the  high  specific  gravity  of  the  urine  (1.025  to  1.035)  depen- 
dent on  the  presence  of  urea  alone  without  sugar.  There  is  in 
these  cases  often  a  remarkable  lassitude  and  apparent  paralysis  of 
the  limbs  suddenly  occurring  after  exertion.  Sometimes  there  is 
emaciation.  Both  these  symptoms  usually  lead  the  patient  and 
his  friends  to  attribute  the  morbid  state  to  insufficient  nutrition, 


INSANITY.  293 

and  to  increase  more  and  more  the  proportion  of  meat  in  spite  of 
the  aggravation  of  the  ailment.  A  rapid  cure  attends  the  dimi- 
nution of  the  meat  meals  to  one  daily,  and  the  supplying  their 
place  with  plenty  of  porridge  and  green  vegetables. 

In  mania,  melancholia,  and  dementia,  the  most  recent  experience 
seems  unanimous  in  recommending  alcohol.  Dr.  Maudsley  makes 
no  distinction  between  them  in  speaking  of  the  therapeutics  of  in- 
sanity, and  indeed  seems  to  proportion  the  strength  of  the  liquor 
to  the  violence  of  the  disease.  He  speaks  of  "  wine  "  as  a  pro- 
phylactic against  madness  in  general,  and  "  brandy  "  as  a  remedy 
in  maniacal  excitement.  I  cannot  find,  as  I  should  have  liked, 
any  warning  bearing  on  cases  which  can  be  traced  to  drunkenness 
in  the  individual  affected,  though  it  can  hardly  be  doubted  that 
such  do  exist,  and  require  special  management.  Even  if  the  se- 
quence of  causation  have  been  reversed,  and  the  intemperance  be 
the  consequence  of  the  madness,  the  association  of  the  two  must 
surely  modify  the  treatment.  It  may  be  that  Dr.  Maudsley  ap- 
proves of  the  homoaopathic  therapeusis  of  alcoholism,  and  his  evi- 
dence to  its  prudence  would  be  very  valuable ;  but  it  should  be 
distinctly  and  boldly  expressed. 

Leaving  this  branch  of  the  question  open,  it  may  be  freely 
granted  that  his  sketch  of  the  current  practice  in  curable  dis- 
orders of  the  intellect  is  correct,  and  his  confidence  in  its  success 
is  not  misplaced.  But  here,  as  in  health,  I  would  limit  the 
quantity,  as  a  rule,  to  that  which  suits  the  stomach  best  and  in- 
creases the  appetite. 

The  advantage  of  an  ample  and  nutritious  diet  in  insanity  is 
daily  more  and  more  forcing  itself  upon  the  proprietors  of  lunatic 
asylums,  though  their  interest  of  course  would  tempt  them  to  an 
opposite  creed.  It  is  good  economy  in  the  end  to  feed  highly 
even  pauper  lunatics,  unused  as  they  may  have  been  to  such  treat- 
ment ;  for  by  such  means  cures  are  effected,  and  the  country  re- 
lieved of  the  charge. 


294  DIETETICS    IN    SICKNESS. 


CHAPTER  VIII. 

SCROFULA,  RICKETS,  AND   CONSUMPTION. 

SECTION  I. 

SCROFULA  is  indubitably  an  hereditary  disease;  and  some  ob- 
servations incline  me  to  the  suspicion  that  the  development  of  the 
ancestral  stain  is  more  common  when  it  is  on  the  maternal  side 
than  when  it  is  derived  from  the  father.  A  faulty  early  nutrition 
would  seem  to  have  as  much  influence  in  drawing  it  out,  as  the 
source  of  the  vital  spark.  For  this  reason  a  mother  who  is  con- 
scious of  the  existence  of  scrofula  in  her  family,  even  should  she 
never  have  been  herself  afflicted,  should  deny  herself  the  privi- 
lege of  suckling  her  infants ;  and  a  healthy  irreproachable  wet- 
nurse  should  be  got  to  supply  her  place.  On  the  other  hand, 
when  it  is  from  the  father's  side  that  danger  is  feared,  it  is  pecu- 
liarly incumbent  on  her  to  play  her  important  part  with  assiduity, 
and  to  protract  the  time  of  lactation  to  its  full  period,  observing 
accurately  the  suggestion  made  in  the  first  chapter  of  the  second 
part  of  this  volume.  I  cannot  too  strongly  urge  the  duty  of  im- 
pressing this  upon  patients. 

The  nursing  mother  will  act  wisely  also  if  she  takes  after  her 
meals  small  doses  of  the  Syrup  of  the  Phosphates,  or  Parrish's 
Chemical  Food. 

Lactation  ended,  the  child's  diet  should  be  arranged  so  as  to 
contain  a  rather  larger  proportion  of  animal  food  than  recom- 
mended for  ordinary  nurseries  and  the  instinct  for  a  carnivorous 
nutriment  should  be  encouraged,  or  at  least  not  thwarted.  Warm 
clothing,  much  sunlight,  frequent  exercise  in  the  open  air,  and  an 
annual  breath  of  sea  air  will  powerfully  aid  in  keeping  off  the 
dreaded  disease. 

The  "weariness  to  the  flesh"  induced  by  overmuch  study  must 
be  sedulously  prevented.  It  spoils  the  appetite  and  digestion,  so 
essential  to  the  object  of  our  care. 


RICKETS.  295 

The  cold  plunge-bath,  well-ventilated  rooms,  moderation  in  the 
pursuits  of  pleasure  and  ambition,  and  a  virtuous  life,  will  usually 
carry  our  patients  safely  up  to  manhood  and  womanhood,  and 
after  that  they  may  be  considered  safe. 

Supposing  the  tendency  is  so  strong  that  in  spite  of  these  pre- 
cautions the  disease  appears,  I  do  then  think  drugs  are  useful,  but 
chiefly  those  which  have  the  nearest  relation  to  aliments,  such  as 
iron,  the  phosphates,  cod-liver  oil.  Their  effect  on  the  appetite 
must  be  carefully  watched ;  and  the  end  must  not  be  sacrificed  to 
the  means — if  they  spoil  the  appetite  they  must  be  left  off  imme- 
diately. 

In  this  case  also,  I  think  alcohol  is  of  service,  employed  with 
the  same  watchfulness  as  articles  of  the  pharmacopoeia. 

SECTION  II. 

Rickets  (Rachitis)  is  distinguished  from  scrofula  by  being  very 
rarely,  if  ever,  hereditary.  It  consists  in  a  softening  of  the  bones, 
especially  of  the  back  bones,  in  children  who  do  not  absorb  enough 
bone-building  materials  in  their  food.  I  think  I  cannot  do  better 
here  than  quote  the  words  of  Dr.  Trousseau,  who,  with  his  usual 
happiness  of  expression,  has  put  before  the  world  the  striking  re- 
sults of  M.  Jules  Guerin's  researches  : 

"  Of  all  causes,  that  most  sure  to  produce  rickets  is  improper 
food. 

"  In  his  first  works  M.  Jules  Guerin  had  adopted  the  idea  gen- 
erally admitted  that  rickets  and  scrofula  are  occasioned  through 
deficient  feeding ;  and  by  that  term,  according  to  vulgar  prejudice, 
was  meant  suckling  carried  on  too  long.  But  his  observation 
taught  him  soon  that  the  direct  converse  of  this  proposition  was 
true,  and  that  the  babies  who  became  rickety  were  not  those  who 
had  been  kept  too  long  at  the  breast,  but  those  on  the  contrary 
who  had  been  prematurely  weaned.  In  fact,  it  appeared  to  be 
true  enough  that  under  the  influence  of  an  insufficient  supply  of 
proper  food,  the  malady  developed  itself;  but  by  proper  food  was 
to  be  understood  something  different  from  what  was  commonly 
meant.  Experiments  tried  upon  animals  made  the  question  quite 
clear.  In  these  experiments  M.  Jules  Guerin  set  himself  to  find 
out  if  it  were  feasible  to  produce  rachitis  at  will.  He  took  a 


296  DIETETICS    IN    SICKNESS. 

number  of  puppies  in  equal  condition ;  and  having  let  them 
suckle  for  a  time,  he  weaned  suddenly  half  the  lot  and  fed  them 
on  raw  meat,  a  diet  which  at  first  sight  would  seem  the  most 
suitable  for  carnivorous  animals.  Nevertheless,  after  a  short  time, 
those  who  continued  to  take  the  mother's  milk  had  grown  strong 
and  hearty,  while  those  who  had  been  weaned  on  an  apparently 
more  substantial  diet  pined,  and  were  taken  with  vomiting  ;  then 
their  limbs  bent,  and  at  the  end  of  four  or  five  months  the  poor 
little  beasts  showed  all  the  symptoms  of  confirmed  rickets.  From 
these  experiments  we  must  conclude  with  M.  Jules  Gue"rin  that 
the  rachitis  depended  in  great  measure  on  the  derangements  of 
nutrition  which  claimed  improper  diet  as  their  cause.  A  diet 
which  is  taken  to  at  a  wrong  season  may  fairly  be  called  improper. 
For  carnivora,  it  is  flesh  before  the  age  of  suckling  has  passed ; 
for  herbivora  (and  an  experiment  bearing  on  the  point  has  been 
made  on  pigs)  it  is  vegetable  feeding,  given  them  too  soon,  when 
they  ought  to  be  still  at  the  teat.  In  the  human  race  the  same 
thing  happens.  Rickets  is  never  so  common  as  it  is  in  babies 
weaned  ere  the  teething  is  forward  enough,  and  brought  up  on 
pap,  vegetables,  or  even  meat."1  It  would  be  waste  of  time  to 
point  the  moral  of  these  valuable  sentences. 

The  daily  addition  to  the  dietary  of  a  small  quantity  of  the 
phosphatic  salts  is  still  more  indicated  here  than  in  scrofula. 

But  still  nothing  can  take  the  place  of  milk,  an  article  of  diet 
in  which  our  laboring  population,  both  in  town  and  country,  is 
sadly  deficient.  I  have  no  fault  to  find  with  coal  clubs  and  cloth- 
ing clubs,  but  I  am  sure  that  as  a  preserver  of  infantile  health  a 
"cow  club"  is  worth  them  all.  Even  the  small  weekly  contri- 
bution, so  difficult  to  extract  from  our  reckless  race,  can  be  dis- 
pensed with,  by  arranging  the  price  paid  on  delivery,  so  as  to 
cover  keep,  insurance,  contract  for  medical  attendance,  and  re- 
placement of  superannuated  animals.  Charitable  help  is  most 
valuable  when  it  takes  upon  itself  the  duty  of  advice  and  super- 
intendence. But  still,  O  Lady  Bountiful,  do  not  give  your  spare 
and  skim  milk  to  the  store  pig,  when  there  are  half  a  dozen  chil- 
dren growing  up  bow-legged  and  crooked  within  half  a  mile  of 

1  Trousseau,  Clinique  Medicale,  vol.  iii,  p.  484,  3me  edition. 


CONSUMPTION.  297 

your  lodge  gate  for  lack  of  it.  Do  not  give  it  at  all,  but  bestow 
the  much  greater  boon  of  selling  it — as  low  as  you  like,  but  still 
sell  it. 

SECTION  III. 

Consumption. — Since  the  introduction  into  our  materia  medica 
of  Cod-liver  oil  by  Dr.  Bardsley  of  Manchester,  the  profession  has 
been  growing  gradually,  but  surely,  convinced  of  the  all-impor- 
tance of  the  dietetic  treatment  of  pulmonary  consumption.  Cod- 
liver  oil  is  a  typical  aliment,  representing  what  is  the  fittest  of  all 
known  substances  to  supply  the  deficiency  that  constitutes  the 
disease.  To  use  the  language  of  microscopic  physiology,  "the 
basis  of  molecular  growth  "  is  poisoned,  so  that  instead  of  actively 
secreting  gland,  or  elastic  tissue,  or  bloodvessel,  or  epithelium, 
etc.,  'fit  for  their  various  duties,  being  formed,  only  a  useless 
cheesy  substance  is  the  product  of  nutrition.  The  due  powers  of 
life  are  lacking  in  it.  We  call  it  "  tubercle,"  and  look  upon  it,  if 
we  are  thougtful  people,  as  an  infant  tissue  strangled  in  its  cradle. 
To  save  then  the  parts  threatened  with  tubercle,  we  must  antici- 
pate the  formation  of  the  imperfect  matter  by  supplying  a  ground- 
work for  perfect  tissue.  This  groundwork  is  laid  by  freshly  as- 
similated oleaginous  substance;  oleaginous  substance  is  what  is 
furnished  by  nature  for  the  primary  growth  and  nutrition  of  all 
the  higher  tissue  of  animal  bodies ;  and  indeed  many  physiologists 
assert  that  without  it  there  is  no  growth  ;  so  that  in  administering 
it,  we  are  closely  imitating  the  wisest  teacher  of  medicine,  mother 
Nature. 

The  reason,  then,  for  giving  cod-liver  oil  is  to  counteract  the 
tendency  to  form  morbid  solids  by  supplying  the  most  suitable 
material  for  healthy  solids — in  short,  by  overcoming  evil  writh 
good.  This  is  a  much  higher  aim  than  the  mere  replacement  of 
the  plumpness  of  flesh  whose  waste  gives  the  name  to  the  disorder. 
The  object  is  not  so  much  to  cure  emaciation,  as  to  cure  the  cause 
of  the  emaciation.  Very  necessary  it  is  to  understand  this ;  for 
not  a  few  tuberculous  and  many  tuberculously  inclined  patients 
are  well  furnished  with  fat,  and  some  are  even  corpulent ;  and 
they  will  demur  to  the  prescription  of  our  remedy,  if  they  are  al- 
lowed to  retain  the  dominant  idea  that  all  it  can  do  is  to  fatten. 


298  DIETETICS    IN    SICKNESS. 

Young  women,  especially,  of  consumptive  families  will  often  ob- 
ject to  the  risk  of  losing  the  elegant  slimness  of  youth,  and  insist 
that  they  are  as  plump  and  round  as  they  ought  to  be.  What 
they  say  may  very  likely  be  true ;  but  yet  their  store  of  fat  can 
only  keep  up  the  temperature  of  the  body,  and  cannot  be  used 
again  for  nutrition.  For  the  purpose  of  nutrition,  recently  as- 
similated fat  is  requisite ;  and  thus  tuberculosis  may  go  on  un- 
checked for  lack  of  it,  even  in  a  corpulent  person,  since  his  store 
of  fat  is  not  available  for  digestive  purposes. 

At  present  cod-liver  oil  is  the  most  readily  assimilated  fat  we 
know  of:  and  so  to  it  all  other  means  of  treating  this  class  of 
diseases  have  a  reference.  Some  substances  ground  their  claims 
for  notice  on  being  substitutes  for  it,  and  drugs  of  various  kinds 
act  beneficially  by  preparing  the  stomach  to  digest  it;  but  any- 
thing which  does  not  look  to  it  for  a  character  is  of  only  acci- 
dental utility. 

I  heartily  wish  that  some  of  the  efficient  substitutes  for  fish-oil 
were  more  agreeable  to  the  palate ;  for  it  must  be  confessed  that 
the  taste  and  smell  are  a  serious  impediment  to  its  employment. 
Suet  is  apparently  the  best :  in  milk  it  is  to  some  persons  not  re- 
pugnant, and  its  digestibility  is  increased  by  its  being  made  into 
an  emulsion  with  one  of  the  gastric  solvents,  to  be  obtained  in 
the  shops  under  the  name  of  "Pancreatic  emulsion."1  Milk,  by 
itself,  comes  next  in  value,  and  a  milk  diet  has  from  the  earliest 
times  been  recommended  in  advanced  phthisis.  But  the  large 
quantity  required  to  be  swallowed,  often  deranges  the  stomach 
and  produces  repugnance ;  so  that  in  recommending  it  to  a  pa- 
tient it  is  necessary  to  warn  him  of  this  difficulty,  and  take  exam- 
ple by  our  master  Hippocrates,  who,  in  advising  a  consumptive 
to  drink  a  large  quart  jug  (rpt-/.6ruXm  mhxd?)  of  mare's  milk  the 
first  thing  every  morning,  adds  significantly  "  if  he  can." 

Devonshire  cream  has  been  used  as  a  substitute,  but  I  cannot 
say  it  has  proved  in  my  hands  an  efficient  one.  If  taken  in 
sufficiently  large  quantities  to  be  of  service,  it  is  apt  to  exercise  a 
purgative  action. 

For  my  part,  I  think  it  is  wisest  to  try  and  get  habituated  to 


1  The  credit  of  introducing  this  to  the  profession  is  due  to  Dr.  Dobell. 

2  Equal  to  two  pints  and  a  quarter. 


CONSUMPTION.  299 

the  fish-oil,  adopting  some  of  the  various  little  devices  which  are 
used  to  diminish  its  nauseousness.  In  the  first  place  it  is  essen- 
tial that  the  article  should  be  the  best  of  its  sort,  that  is,  as  free 
from  smell,  taste,  and  color  as  possible,  showing  its  careful  and 
recent  preparation.  Though  they  do  not  always  tell  their  custom- 
ers, the  importance  of  this  freshness  is  well-known  to  manufactu- 
rers. I  learnt  so  when  prescribing  it  for  a  stranger  a  few  years 
ago :  her  husband,  who  was  present,  stopped  me  when  I  was  de- 
scribing what  cod-liver  oil  should  be,  saying  he  knew  all  about 
that,  for  he  made  it,  and  engaged  that  she  should  have  it  fresh 
prepared  daily. 

Some  patients  will  take  the  oil  easiest  in  milk.  Some  find  the 
taste  annulled  by  eating  a  piece  of  red  herring,  or  anchovy,  or 
sardine,  before  and  after  the  dose.  Some  like  the  bitter  aromatic 
of  coffee  to  counteract  the  rankness ;  and  this  fancy  I  am  glad 
always  to  hear  of;  for  it  gives  an  opportunity  for  recommending  a 
bitter  drug  which  assists  powerfully  in  the  assimilation  of  the  oil. 
If  coffee  is  approved  of,  I  then  advise  the  oil  to  be  taken  as  a 
parenthesis  in  a  mixture  of  quinine,  or  of  strychnine,  or  of  both 
together.  A  sip  of  the  medicine  is  to  be  taken,  then  the  oil 
swallowed,  and  washed  down  with  the  remainder  of  the  draught. 
If  there  is  persistent  nausea  afterwards,  a  few  drops  of  hydro- 
cyanic acid  may  be  added  each  time.  Nausea  may  also  be 
avoided  by  taking  the  oil  on  going  to  bed.  Where  there  is 
cough,  the  sheets  should  be  previously  warmed. 

But  the  taking  of  cod-liver  oil  is  not  an  exemption  from  all 
other  care.  The  student  of  the  literature  of  the  subject  will  find 
his  faith  claimed  by  two  extreme  parties,  one  of  which  is  all  for 
beefsteaks,  porter,  and  in  short  for  as  carnivorous  a  diet  as  possible, 
the  other  in  favor  of  pulse  and  herbs,  seeds  and  potatoes.  Both 
are  as  far  right  and  as  far  wrong  as  it  is  probably  possible  to  be. 
They  are  quite  right  in  what  they  include,  and  quite  wrong  in 
what  they  exclude.  The  food  should  be  as  near  that  of  health  as 
the  digestion  of  the  patient  will  allow,  that  is  to  say,  mixed  and 
varied,  liberal  in  frequency,  and  moderate  in  quantity.  The 
whims  of  appetite  should  not  be  thwarted,  nor  the  prejudices  of 
theory  indulged :  the  demands  of  muscular  exertion  should  be 
provided  for  by  the  starchy  ingredients  of  the  dietary,  and  the 
increased  wear  and  tear  of  the  machinery  by  the  nitrogenous. 


300  DIETETICS    IN    SICKNESS. 

The  full  powers  of  digestion  should  be  brought  into  activity 
by  plenty  of  open  air  and  exercise  within  the  bounds  of  weariness. 
And  this  is  the  reason  why  English  patients  are  advised  to  live 
during  the  winter  months  in  more  genial  climes  than  their  own. 
They  get  thus  more  sunlight  and  oxygen  without  damp.  But 
also  the  change  is  good ;  for  it  has  been  found  that  to  those  living 
in  parts  of  Britain  where  the  atmosphere  is  soft  and  mild,  as  in 
the  West,  a  colder  and  more  bracing  air,  provided  it  be  dry,  is 
sometimes  beneficial.  From  Cornwall  the  small  trading  vessels 
will  sometimes  carry  a  consumptive  miner  to  pass  the  winter  in 
Greenland ;  and  patients  have  been  sent  with  advantage  from 
such  localities  as  Leghorn  to  the  exhilarating  sharpness  of  a  snow- 
clad  Alpine  upland.  But  this  plan  requires  great  caution. 

Much  more  confidently  can  the  recommendation  be  given  that 
the  advantages  of  a  sea-life  should  be  favorably  put  before  the 
youths  of  families,  where  there  is  an  ancestral  tendency  to  pul- 
monary tubercle.  I  do  not  mean  that  they  should  be  driven  into 
it  against  their  will,  but  that  it  should  be  made  as  attractive  as 
possible.  The  healthy  state  of  a  young  sailor's  digestive  organs 
is  the  best  guarantee  that  can  be  obtained  against  consumption. 

As  to  the  use  of  alcohol  in  threatened  cases,  and  in  the  early 
stages  of  tubercle,  I  have  no  hesitation  in  pronouncing  an  opinion 
adverse  to  it.  But  if  the  morbid  matter  has  broken  down,  and 
there  is  either  nocturnal  perspiration,  copious  purulent  expectora- 
tion, diarrhoaa,  extreme  emaciation,  or  depression  of  spirits,  wine, 
especially  port  wine,  in  quantity  equal  to  the  occasion,  is  often  of 
decided  use.  When  the  demand  for  it  has  passed  away,  it  may 
be  left  off. 


DISEASE    OF    THE    HEART.  301 


CHAPTER  IX. 

DISEASE   OF  THE   HEART   AND   ARTERIES. 

SECTION  I. 

• 

IN  disease  of  the  heart  the  most  remarkable  change  in  respect 
of  digestion  is  the  slowness  with  which  liquids  are  absorbed  by 
the  stomach.  If  much  is  drunk  at  once,  it  will  remain  a  long 
time  gurgling  about,  and,  instead  of  assisting  digestion,  will  offer 
an  impediment  and  cause  inconvenience.  The  reason  of  this  is 
the  slackening  of  the  circulation  of  the  blood,  which  is  directly  or 
indirectly  effected  by  all  the  various  cardiac  lesions  in  common. 
Whether  the  heart  is  too  thick  or  too  thin,  too  large  or  too  small, 
whether  the  openings  of  valves  are  obstructed  by  warty  growth, 
or  whether  their  stretched  curtains  fail  to  control  the  flux  and 
reflux  of  the  current,  the  practical  result  is  one,  namely,  that  the 
vital  stream  is  unnaturally  sluggish.  Now  it  is  a  well  known 
law  governing  the  passage  of  liquids  through  membranes  that  it 
is  promoted  by  the  rapid  movement,  and  retarded  by  the  sluggish 
movement,  of  the  fluid  towards  which  the  endosmosis  is  tending. 
It  is  clear,  therefore,  that  the  absorption  of  potables  from  the 
digestive  canal  into  the  blood  must  be  deficient  in  close  propor- 
tion to  the  obstruction  presented  by  the  defective  machinery  of 
the  circulation. 

The  observation  of  a  dry  diet  contributes  greatly  to  the  com- 
fort of  the  patients  now  being  considered.  The  dinner  should 
never  be  prefaced  by  soup,  and  the  drink  should  be  taken  only 
in  sips  during  the  meal.  And  what  is  taken  should  not  be  cold, 
but  at  least  have  the  chill  taken  off.  When  thirst  occurs  between 
meals,  the  same  rule  of  sipping  should  be  observed.  In  this  way 
quite  a  sufficiency  to  supply  the  requirements  of  the  kidneys  may 
be  introduced — indeed,  more  is  probably  got  into  the  blood  than 
when  larger  quantities  arc  gulped  down  at  once,  chilling  and  par- 
alyzing the  absorbent  powers  of  the  mucous  membranes. 


302  DIETETICS    IN    SICKNESS. 

Independent  of  the  inconvenience  which  the  indigestion  of  fluids 
causes,  it  may  be  feared  also  that  the  distension  of  the  stomach 
accompanying  it  interferes  with  the  already  laborious  action  of 
the  heart,  and  aggravates  the  organic  source  of  the  malady.  This 
is  especially  the  case  in  Dilatation  with  Thinning  of  the  heart's 
walls,  and  is  least  noticeable  in  Valvular  Disease. 

Where  Heart-disease  is  complicated  with  obesity,  especially  if 
the  fat  is  accumulated  in  the  chest,  the  enforcement  of  a  dry  diet 
is  still  further  to  be  viewed  as  imperative;  inasmuch  as  it  con- 
tributes powerfully  to  the  reduction  of  the  hypertrophied  adipose 
tissue. 

The  only  symptom  which  may  perhaps  render  it  a  doubtful 
policy  is  the  occurrence  of  dropsy.  Should  this  be  very  decided, 
it  is  of  importance  to  keep  the  kidneys  active  to  a  degree  that  can 
be  accomplished  only  by  the  ingestion  of  a  considerable  supply  of 
watery  drink.  I  think,  however,  this  should  be  always  followed 
up  by  purgative  medicines,  often  even  by  mercurials.  And  when 
the  necessity  has  ceased,  the  dry  regimen  should  be  resumed. 

The  dietary  of  persons  with  imperfect  hearts  should  be  at  least 
as  nitrogenous  as  if  they  were  completely  sound.  What  we  have 
to  dread  is  the  atrophic  degeneration  of  the  cardiac  muscle,  for 
till  this  degeneration  occurs  the  original  lesion  is  not  aggravated ; 
and  the  constitution  often  gets  so  used  to  the  state  of  mechanism 
of  the-  heart  that  no  inconvenience  of  any  kind  is  felt.  And 
atrophic  degeneration  is  warded  off  by  keeping  up  the  redness  and 
fluidity  of  the  arterial  blood. 

The  importance  of  the  existence  or  non-existence  of  valvular 
disease  lies  not  in  the  injury  it  directly  inflicts,  as  in  the  likeli- 
hood of  the  induction  of  other  lesions  of  the  heart.  If  the  mus- 
cular structure  remains  healthy,  injured  valves  do  not  appear 
capable  of  causing  death.  But  very  surely  are  they  fatal  when 
they  are  followed  by  dilatation  or  thickening  or  degeneration  of 
the  cardiac  walls,  with  the  sad  train  of  dropsies,  apoplexy,  pul- 
monary hemorrhage,  etc. 

In  2161  post-mortem  examinations  at  St.  George's  Hospital  in 
ten  years,  the  cardiac  valves  were  diseased  without  the  walls  of 
the  heart  being  affected  113  times;  but  in  every  case  there  were 
other  lesions  amply  sufficient  to  account  for  death  quite  indepen- 
dent of  the  valves,  such  as  accidents,  surgical  complaints,  cancer, 


DISEASE    OP    THE    HEART.  303 

low  fever,  etc.  In  one  alone,  where  anasarca  from  granular  kid- 
neys was  the  immediate  cause  of  death,  could  any  symptom  be 
debited  to  diseased  valves  with  healthy  heart,  and  that  symptom 
was  pulmonary  hemorrhage.1 

In  the  classes  of  people  represented  by  hospital  patients,  the 
probability  that  valvular  disease  will  be  followed  by  its  unhappy 
consequences  is  very  great.  When  a  patient  thus  affected  leaves 
our  hospital  wards,  we  expect  to  see  him  again  shortly,  and  on 
each  fresh  admission  with  a  more  severe  complaint.  But  the 
same  expectation  must  not  be  applied  to  the  more  comfortable 
classes  of  society.  Persons  in  easy  circumstances  have  valvular 
lesions  for  years  and  years,  perhaps  through  the  greater  part  of  a 
long  life,  and  not  only  continue  to  live,  but  even  fail  to  experi- 
ence symptoms  bad  enough  to  consult  a  medical  practitioner. 

In  my  volume  of  Clinical  Lectures2  I  gave  some  two  dozen  ex- 
amples of  persons  found,  when  examined  for  insurance,  to  have 
valvular  lesions,  but  who,  during  periods  varying  from  50  years 
doAvn wards,  had  not  in  anywise  suffered  in  consequence.  This  I 
attribute  to  their  not  being  dependent  for  daily  bread  on  daily 
labor — in  fact,  to  ease  of  mind  and  body. 

The  renewal  of  the  destroyed  tissue  being  impossible,  and 
equally  so  any  mechanical  compensation  for  the  arrested  function, 
it  is  obvious  that  in  the  treatment  of  the  disorganized  valves  them- 
selves, restorative  medicine,  in  the  strictest  sense,  must  be  quite 
at  fault.  But  indirectly  it  is  almost  as  effective  in  prolonging 
life,  as  if  it  could  put  in  a  new -valve,  or  make  another  muscle  do 
duty  for  the  resting  ventricle.  It  may  repair  those  reparable 
conditions  which  are  injurious,  and  which  by  bringing  on  enlarge- 
ment constitute  the  real  danger  in  cardiac  cases.  Let  us  try  and 
cure  what  is  curable,  and  trouble  ourselves  as  little  as  possible 
about  bygone  injuries. 

While  we  bid  our  patients  live  generously,  we  must  disabuse 
them  of  the  notion  that  the  advice  includes  a  free  allowance  of  al- 
cohol. Alcohol  is  really  the  most  ungenerous  diet  possible.  Ad- 
diction to  it  impoverishes  the  blood,  and  is  the  surest  road  to  that 


1  Dcccnnium    Pathologicum,   MS.    in   library  of  Medico-Chirurgieal   So- 
ciety, chap.  x,sect.  i. 

2  Lcet.  xxv. 


304  DIETETICS    IN    SICKNESS. 

degeneration  of  the  muscular  fibres  which  is  so  much  to  be  feared. 
And  in  diseases  of  the  heart  it  is  especially  hurtful,  by  quicken- 
ing the  beat,  causing  capillary  congestion  and  irregular  circula- 
tion, and  mechanically  dilating  the  cavities.  Let  the  fermented 
drink  be  limited  to  that  quantity  which  increases  the  appetite. 
In  a  great  many  instances  this  may  be  very  shortly  described  as 
none  at  all,  but  often  also,  whether  from  the  force  of  habit,  or  the 
nature  of  the  constitution,  a  sip  of  wine  enables  a  sufficient  din- 
ner to  be  eaten,  and  more  fully  digested  than  when  not  thus  as- 
sisted. Burgundy  and  Champagne  are  the  best  adapted  for  the 
purpose,  as  a  small  quantity  of  these  wines  is  inspiriting,  with  a 
minimum  of  alcoholic  contents. 

SECTION  II. 

In  the  treatment  of  Aneurism  the  science  of  diet  plays  a  part 
different  from  that  which  it  plays  in  any  other  diseases  which  we 
have  been  reviewing.  In  them  it  aims  at  restoring  health  by  re- 
placing what  is  deficient,  and  bringing  the  body  directly  into  a 
state  as  near  the  full  natural  state  as  possible.  Here  its  intention 
more  resembles  that  of  a  drug ;  it  would  bring  the  blood  tempo- 
rarily into  a  morbid  condition,  to  accomplish  a  certain  definite  ob- 
ject; it  makes  a  sacrifice  to  realize  a  future  advantage. 

By  Aneurism  I  mean  the  formation  of  a  pouch  in  an  artery 
through  the  yielding  of  the  sides  of  the  tube.  The  danger  is  lest 
they  should  go  on  yielding,  burst,  and  let  out  the  lifeblood. 
Therefore,  if  the  artery  be  a  small  one,  and  capable  of  being 
spared  till  it  is  replaced  by  a  collateral  circulation,  mechanical 
surgery  can  save  life  by  tying,  compressing,  obliterating  it,  or  by 
removing  the  limb  where  it  is  situated.  In  the  largest  arteries 
such  trenchant  treatment  is  obviously  impossible ;  yet  there  are 
found  from  time  to  time  instances  of  aneurism  in  even  the  largest 
arteries  being  rendered  innocuous  by  a  natural  process.  In  pa- 
tients who  have  died  of  other  diseases,  the  pouch  has  been  found 
plugged  up,  and  leakage  prevented  by  a  firm  caulk  of  fibrin, 
clotted  out  gradually  from  the  blood.  It  is  usually  adherent  to 
the  roughened  or  torn  sides  of  the  artery. 

Why  is  not  this  happy  cure  always  found  ?  In  a  great  many 
cases  because  the  mouth  of  the  pouch  is  so  wide  and  open  that  the 


ANEURISM.  305 

blood  cannot  stagnate  long  enough  to  form  a  clot.  But  in  others 
also,  because  the  fluid  is  so  rioh  in  non-coagulating  material  (to 
wit,  blood-disks)  that  it  coagulates  with  difficulty,  and  under  some 
circumstances  not  at  all. 

In  such  a  case — that  is  to  say  in  a  person  whose  fresh  color, 
muscular  development,  and  good  digestion  show  him  to  be 
healthy-blooded — if  an  aneurism  forms,  the  best  chances  of  restor- 
ation to  safety  are  to  be  sought  in  making  the  circulating  liquid — 
first,  unnaturally  stagnant,  and  secondly,  unnaturally  coagulable. 

These  objects  can  be  attained  by  keeping  the  patient  in  bed  and 
starving  him.  Thus  is  produced  an  artificial  anaemia,  a  state  of 
blood  in  which  the  red  disks  are  deficient,  and  the  fibrin  is  in  ex- 
cess, a  state  in  which  coagulation  is  at  its  maximum,  and  the  force 
of  the  heart  at  its  minimum.  The  method  is  commonly  known 
as  Valsalva's,  and  it  has  met  with  a  sufficient  measure  of  success 
to  warrant  a  trial  of  it  being  made  in  every  case  where  no  impedi- 
ments lie  in  the  way.  About  fifteen  years  ago,  I  published  a 
clinical  lecture  on  several  patients  treated  thus,  and  I  concluded 
that  u  not  merely  is  it  the  best  mode,  but  the  only  honest  mode, 
of  treating  aneurisms  of  the  trunk  vessels;  because  it  is  the  only 
one  we  at  present  know  consonant  to  reason  and  experience."1 

The  most  successful  cases  are  those  where  the  sac  is  in  the  de- 
scending and  abdominal  aorta,  as  that  of  the' stone-mason  I  men- 
tioned in  the  lectures  just  quoted.  Yet  others  are  not  to  be  des- 
paired of.  In  the  "British  Medical  Journal "  (December  16th, 
1865)  is  published  a  case  by  Dr.  Waters  of  Liverpool,  of  thoracic 
aneurism  successfully  treated  by  rest  and  low  diet,  and  Mr.  Tuf- 
nell  of  Dublin  has  advocated  its  use  in  those  cases  of  aneurism 
which  would  come  under  the  care  of  a  surgeon. 

Bread  and  water,  or  pudding  and  water,  as  advised  by  Yalsalva, 
and  used  as  punishment  diet  at  prisons,  is  the  most  effective. 
Valsalva  gave  as  little  as  half  a  pound  of  pudding  in  the  morn- 
ing, and  half  a  pound  in  the  evening,  till  the  pulsation  of  the 
tumor  was  arrested,  and  then  he  gradually  increased  the  quantity 
till  ordinary  diet  was  resumed,  carefully  watching  against  a  re- 
lapse, however,  during  this  latter  process.  And  I  agree  that  it  is 
better  at  once  to  try  the  experiment  with  extreme  rigor,  and  give 

1  Lectures  Chiefly  Clinical,  lect.  xxiv. 
20 


306  DIETETICS    IN    SICKNESS. 

it  up  if  necessity  will  have  it  so,  than  to  shiver  and  vacillate  on 
the  brink  of  the  serious  struggle  for  life,  perhaps  too  late  to  be  of 
use. 

The  confinement  to  bed  must  be  absolute. 

To  the  future  conduct  of  those  who  have  suffered  from  aneu- 
rism, and  in  whom  a  recurrence  of  the  disease  is,  of  course,  to  be 
feared,  it  is  obvious  that  the  principles  above  advocated  do  not 
apply.  The  formation  of  an  aneurismal  sac  is  a  degenerative  pro- 
cess ;  and  starvation,  bleeding,  and  confinement  to  bed  would  be 
most  deleterious,  as  tending  to  induce  further  debility  and  degen- 
eration. The  ansemic  dietary  is  for  the  sole  purpose  of  bringing 
about  the  formation  of  a  clot,  and  the  prevention  of  further  degen- 
eration of  the  arteries  must  follow  an  opposite  path.  Iron,  nu- 
tritious food,  good  dry  air,  moderate  exercise,  and  suitable  cloth- 
ing should  be  perseveringly  adhered  to  for  the  rest  of  the  patient's 
life. 

I  would  strongly  advocate,  also,  in  the  interests  of  the  digestive 
organs,  a  change  from  the  climate  of  England,  where  degenera- 
tive disease  is  the  rule,  and  acute  disease  the  exception,  to  Italy, 
where  degenerative  disease  is  the  exception  and  acute  disease  the 
rule — a  change,  if  not  for  life,  at  all  events  for  long  enough  to 
alter  the  constitution.  It  may  be  remarked  that  it  is  in  the  ab- 
sence of  aneurism  that  this  peculiarity  of  the  Italian  climate  is 
shown.  In  the  statistics  of  Milan  Hospital  (Rendiconto  della 
Benificenza  dell'  Ospetale  Maggiore,  etc.,  1862),  I  find  but  4  in- 
stances of  thoracic  aneurism  in  61,761  patients,  or  1  in  15,440 ; 
whereas  at  St.  Mary's  Hospital,  London,  I  find  29  in  7319  pa- 
tients, or  1  in  252.  Again,  at  Genoa  I  find  the  last  published 
bills  of  mortality  (for  1860,  printed  by  Dr.  Giovanni  du  Jardin) 
without  any  deaths  by  aneurism.  The  corresponding  report  for 
London  contains  103.  The  differences  are  so  great,  that  the  lim- 
ited range  of  the  observation  is  unimportant,  and  I  cannot  but 
conclude  that  there  is  something  in  the  climatic  influences  of  Lon- 
don favorable  to,  and  something  in  Milan  and  Genoa  antagonistic 
to,  the  formation  of  aneurism. 


INDEX. 


Acids  in  atonic  dyspepsia,  254 
Adulteration,  definition  of,  218 
Ague,  290 
Air,  as  a  defence  against  intoxication, 

221 

Albuminuria,  272 
Alcohol,   abstinence    from,   in   gout, 

263 
action  (physiological)  of,  107,  200, 

273 

beneficial  effects  of,  216 
different  forms  of,  73,  217,  235, 

290 

influence  of  nationality  in   con- 
sumption of,  221 
injurious  to  children,  137,  226 
hysterics,  282 
nurses,  126 
moral  effects  of,  221 
use  of  in  atonic  dyspepsia,  256 
consumption,  300 
fevers,  235 
Alkaline  drink,  248 
Almonds,  51,238,  276 
Aneurism,  304 
Arrowroot,  72,  238 
Artichoke,  46 
Artichokes,  Jerusalem,  44 
Asparagus,  43,  45 
Athletic  training,  155,  181 
Athleticism,  evils  of,  263 
Atonic  dyspepsia,  217,  252 


Bacon,  61,  280 
Bael  drink,  238 
Barley,  71 

water,  85,  237 
Bathing,  163,  258,  295 
Batter  pudding,  243 
Bed,  lvinor-in,  167 
Beef  tea,  131,  239,  275 
Biscuits,  70 

and  milk,  243 
Boils,  166,  172 
Brain,  concussion  of,  291 


Bread,  68,  254 

brown,  280 

pudding,  243,  249 

sauce,  242 

soup,  248 

Bright's  disease  of  kidneys,  213,  272 
Butter,  66 
Buttermilk,  65 


Cabbage,  43,  45 

Cardoons,  46 

Carnivora,  flesh  of,  275 

Carrots,  44 

Caviare,  41,  60 

Celery,  49 

Cellulose,  conversion  into  sugar,  59 

Change  of  air,  182,  265,  300 

Chantarelles,  47 

Cheerfulness,  116,  199,  229,286 

Cheese,  67,  254,  275 

Chestnuts,  46 

Chewing,  105,  108 

Chicken  and  "  Hen  "  broth,  240 

Children,  diet  of,  134 

Chocolate,  55,  96 

Cirrhosis  from  alcohol,  213 

Claret  cup,  85.  238 

Cleanliness,  48,  50,  87,  97,  163 

Climate,  effects  of,  175,  221 

in  atonic  dyspepsia,  259 
in  consumption,  300 
in  gout,  264 
of  Italy,  265,  306 

Clotted  cream,  66 

Cocoa,  55,  96 

Cod-oil,  297 

Coffee,  55,  96 

Commercial  life,  diet  of,  140 

Condy's  wash,  239 

Constipation,  252,  257,  278 

Consumption,  pulmonarv,  297 

Cookery,  52,  87,  106 

Corpulence,  reduction  of,  166 

Crabs,  42 

Cream,  298 


808 


INDEX. 


Cucumber,  43,  49 
Cups,  85 
Curayoa,  85 
Curds,  65 


Degeneration,  arterial,  from  alcohol, 
215 

in  meat,  32,  37,  38 
Delirium  trcmens,  212,  '284 
Diabetes,  274 
Diarrhcen,  171 
Diet,  dry,  301 

Digestibility,  degrees  of,  114 
Digestible,  meaning  of,  111 
Digestion,  101 

time  of,  99 

Diluents,  50,  51,  85,  113,  250,  277 
Disease,  transmission  of,  in  meat,  37 

in  milk,  63 
Dress,  136,  165,  180 
Ducks,  39 
Dynamic  equivalents,  24 


Eel  broth,  242 
Egg  nogg,  239 

soup,  239 

Eggs,  39,  59,  67,  98,  100 
Emotion.,  action  of,  110 
Endosmosis,  111 
Enemata,  nutritive,  235,  242.  288 


Fagot,  for  flavoring,  281 

Famine,  176,  194 

Fasting,  121,  195 

Fevers,  diet  and  regimen  of,  231 

Fish,  40 

Flatulence,  252,  259 

Flavorings,  49,  93,  97,  281 
poisonous,  218 

Flounders,  260 

Food  and  work,  23,  28 
natural,  of  man,  17 
quantity  of,  22,  27,  28,  120 

Fraud,  60  (note),  62,  69,  71,  78,  218 

French  beans,  47,  275 

Fruit,  51,246,  275 

Fusel-oil,  81,  218 


Game,  39,  40 
Geese,  40 
Gelatin,  249 
Gluttony,  137 
Gout,  247,  261 

in  the  stomach,  268 
Grape  sugar,  56,  73 
Gravel,  270 


Grits,  71,  238 
Groceries,  52 


Habit,  force  of,  18 
Ham,  61,  170 
Hartshorn  drink,  248 

jelly,  249 

Heart,  disease  of,  301 
Heat,  113 

Hvpochondriasis,  292 
Hysteria,  282 

in  the  male,  284 


Ice,  85 

Infants,  diet  of,  125 

Inflammation,  diet  for,  245 

Insanity,  293 

Intemperance,  dangers  of,  213,  220 

Iron  in  medicine,  82,  258,  259,  295 


Junkets,  65 


Kidneys,  activity  of,  defence  against 

alcohol,  221 
diseases  of,  270 


Leeks,  44 

Lemonade.  85r  237 

Lentils,  47 

Lettuces,  50,  281 

Liehig's  food  for  infants,  130 

Linseed  tear  237 

Literary  life,  diet  of,  144 

Liver,  sluggish,  252 

use  of,  122 
Luncheon,  49,  137,  166,  253 


Macaroni,  57,  176 

Maize,  71 

Malt  liquors,  80,  277 

tea,  243 

Mayonnaise,  260 
Meals,  times  of.  117 
Meat,  choice  of,  29 

storing  of,  100 
Milk,  20,  62,  126 

boiled,  170 

diet,  274,  297,  299 

gouts',  170 
Mineral  waters,  84 
Mixed  diet,  20 
Morels,  47 

Mothers,  diet  of,  126 
Mould,  blue,  64 
Mushrooms,  47 


INDEX. 


309 


Mustard,  61,  269 
Mutton  broth,  241,  250 
club,  34 


Neuralgia,  291 

Noxious  trades,  152 

Nurse,  choice  of,  236 

Nutrition,  122 

Nutritiousness,  comparative,  123 

Nuts,  51 


Oatmeal,  71 

flummery,  281 

tea,  251' 
Obesity,  302 
Oil,  59,  170 
Old  age,  189,  197 
Olives,  59,  275 
Oxalate  of  lime,  270 
Oysters,  42 


Panado,  239 

Parsnips,  44 

Partridge,  40,  89.  242 

Peas  and  beans,  46.  47,  59,  274 

Pepper,  60,  255,  259 

Pepsin,  235,  256,  258 

Phosphates  in  medicine,  294 

urine,  271 
Physicking,  138 
Pickles,  60 
Pigeon,  212 
Porridge,  280 
Potato  surprise,  260  / 
Potatoes,  43 

for  invalids.  244 
Poultry,  39 
Poverty,  91,  192 
Preserved  food,  94,  99 
Professional  life,  diet  of,  144 
Puff-bull,  47 
Purgatives,  278,  288 


Kaisins,  56 
Kennet,  67,  237 
Rheumatic  fever,  diet  in,  246 
Rheumatism,  chronic,  269 
Rice,  57 

gruel,  238 

in  broth,  241 

milk,  260 

pudding,  243 
Rickets,  132,  295 
Riding,  268 
Rose  tea,  250 

Rosin,  use  of,  in  wine,  219 
Rot  in  sheep,  32 


Rowing,  136,  157,  165 
Rye,  71 


Sage  tea,  253 

Salad,  48,  254 

Salsify,  44 

Salt,  use  of,  in  wine,  219 

Raiting,  94 

Sauce,  universal,  97  (note),  255,  259 

Sausages,  61 

Scrofula,  294 

Seakale,  44 

Sea-sickness,  173 

Semolina,  57 

Shell-fish,  42 

Sleep,  want  of,  172,  198,  217 

Soup  for  poor,  91 
meagre,  248 

Sour  crout,  45,  111 

Spices,  61 

Spinach  soup,  281 

Spirituous  liquors,  80 

Starch,  conversion  of,  106 

Starvation,  184,  245,  305 

Stomach  cough,  257 

Suet,  298 

Sugar,  55 

action  of,  in  digestion,  256 
formation  in  body,  106,  123,  274 

Sunstroke,  291 

Swiss  condensed  milk,  65,  130 


Tea,  53,  119 

for  invalids,  244 

Teeth,  17,  108 

Teething,  132 

Temperance  societies,  228 

Temperature,  influence  of,  in   diges- 
tion, 247 

Toast  and  water,  85 

Tomatoes,  46,  49 

Travelling:,  hints  about,  169 

Treacle,  56 

Trichina,  36 

Truffles,  47 

Tubercle,  softening  of,  arrested  by  al- 
cohol, 217 

Turkeys,  40,  89 

Turtle,  41 


Uric  acid,  270 


Variety,  114,  119,  135,  254 
Vegetable  food,   uses  of,  42,  49,  194, 

254,  263,  279,  292 
marrow,  46 


310 


INDEX. 


Vegetables,  cookery  of,  92 

storing  of,  100 
Vermicelli,  57 
Vichy  water,  248,  258 
Vinegar,  57,  170 

Voisin,  on  idiocy  produced  by  alco- 
hol, 216 


"Water,  choice  of,  81 

as  a  remedy,  219,  279 
gruel,  71,  237 

Whey,  65,  236,  238 


Wine,  72 

light,  beneficial  influence  of,  2J7, 
266 

in  old  age,  198 

red,  280 

Winter  greens,  45 
Worms,  round,  50 

tape,  34 


Yams,  44 
Yeast,  70 


PAVY  ON  FOOD.— Just  Issued. 


A  TREATISE  ON  FOOD  AND  DIETETICS, 

PHYSIOLOGICALLY  AND  THEBAPEUTICALLY  CONSIDERED. 
BY  F.  W.  PAVY,  M.D.,  F.R.S., 

Physician  to  and  Lecturer  on  Physiology  in  Guy's  Hospital. 
In  one  very  neat  octavo  volume  of  nearly  six  hundred  pages  ;  cloth,  $4.75. 

No  modern  treatise  on  this  subject  having  existed  in  the  English  language,  Dr.  Pavy's  work 
supplies  a  want  which  has  been  very  seriously  felt,  and  in  a  manner  which  shows  that  the 
author  is  an  extensive  reader  and  has  judicious-ly  arranged  the  numerous  facts  and  theories, 
together  with  the  most  striking  experiments  and  the  deductions  drawn  therefrom.  It  seems 
to  us  that  he  has  truly  conferred  a  great  benefit  upon  all  interested  in  the  subject-matter  of 
his  work,  and  that  nobody  will  study  its  pages  without  having  derived  valuable  instruction 
therefrom,  and  without  considering  it  not  only  useful,  but  next  to  indispensable. — Amer.  Jour, 
of  Pharmacy,  Aug.,  1874. 

The  present  book  is  a  result  of  his  work  in  this  direction,  and  is  well  calculated  to  do  credit 
to  his  perseverance  in  collecting  facts,  and  his  judgment  in  arranging  them  in  an  entertain- 
ing, as  well  as  a  practical  form.  It  is  but  rarely  that  we  have  had  offered  us  so  much  practi- 
cal information  in  so  agreeable  a  manner  as  is  done  by  I)r.  Pavy  in  the  present  instance. — 
New  Remedies,  July,  1874. 

Not  pretending  to  contain  much  original  research,  it  presents  an  admirably  clear,  full,  well 
digested  account  of  all  important  facts  and  theories  on  the  supply  of  force  and  material  in 
the  human  organism.  The  size  of  the  work,  the  concise  ness  of  its  style,  the  extent  of  its  in- 
formation, the'  completeness  of  its  scope,  and  the  general  accuracy  of  its  statements  reflect  not 
less  credit  on  the  industry  than  on  the  ability  of  its  author. — London  Lancet,  Oct.  10,  1874. 

AVe  can  very  cordially  commend  the  book  to  our  readers.— Brit,  and  For.  Med.-Chlr.  Rev., 
Oct.,  1874. 

The  work  will  amply  repay  the  reader,  whether  professional  or  general,  and  should  find  a 
place  in  the  libraiy  of  every  physician,  in  the  dispensary  of  every  hospital,  and  would  consti- 
tute a  valuable  addition  to  the  household  library. — Chicago  Med.  Journ.,  Nov.,  1874. 

In  one  word,  Dr.  Pavy  has  favored  his  brethren  with  an  admirable  book  on  a  most  interest- 
ing and  important  subject.  When  the  practice  was  to  reduce  the  diet  of  the  sick  to  the  mini- 
mum compatible  with  existence,  physicians  might  dei-pise  dietetics;  but  since  one  of  the  great 
points  in  practice  has  come  to  be  the  support  of  our  patients  by  suitable  aliment,  the  study  of 
food  has  become  one  of  the  most  important  iu  medicine. — Am.  "Practitioner,  Oct.,  1874. 

It  is  seldom,  indeed,  that  we  have  the  good  fortune  to  read  so  admirable  a  book  as  this  treat- 
ise of  Dr.  I'avy.  A  feeling  of  satisfaction  is  always  IV-lt  in  the  reader's  mind  when  the  author 
writes  eUarly,  instructively,  and  as  master  of  his  subject .;  and  thrse  three  characteristics  are 
found  combined  in  the  work  before  us — a  work  which  is  sure  to  become  a  standard  authority 
on  the  subject  of  which  it  treats,  and  which  we  have  great  pleasure  in  recommending  to  the  at- 
tentive study  of  our  readers  —Dublin  Joum.  of  Med.  Sci.,  Oct ,  1874. 


BY  THE  SAME  AUTHOR— Lately  Issued. 

A  TREATISE  ON  THE  FUNCTION  OF  DIGESTION:  Its  Disorders,  and  their  Treatment. 
By  F.  W.  Pavy,  M.D.,  F.R.S.,  Senior  Assistant  Physician  to,  and  Lecturer  on  Physiology 
at,  Guy's  Hospital,  etc.  From  the  Second  London  Edition.  In  one  very  handsome  octavo 
volume  of  about  250  pages;  extra  cloth,  $2.00. 

It  is  a  model  of  its  kind.  The  author  has  a  happy  faculty  of  entertaining  as  well  as  instruct- 
ing his  reader,  combining,  so  to  speak,  pleasure  willi  profit.  Accustomed  as  a  teacher  to 
present  salient  points,  he  succeeds  admirably  in  outlining  his  subject.— N.  Y.  Med.  Record, 
Sept.  1,  1869. 

This  work  is  well  worthy  careful  perusal,  and  should  be  in  the  library  of  every  practitioner. 
— St.  Louis  Mcd.  Archives,  Sept.,  1869. 

In  the  field  thus  defined  Dr.  Pavy  has  given  us  the  most  satisfactory  essay  yet  published. — 
N.  Y.  Med.  Gazette,  Aug.  28,  1869. 


HENRY  C.  LEA,  Philadelphia. 


FOX  ON  THE  STOMACH.— Now  Ready. 


THE  DISEASES  OF  THE  STOMACH. 

Being  the  Third  Edition  of  the  "Diagnosis  and  Treatment  of  the  Varieties  of  Dyspepsia." 

BY  WILSON  FOX,  M.D., 

Holme  Professor  of  Clinical  Medicine,  University  College,  London. 

Revised  and  enlarged  with  illustrations,  in  one  handsome  octavo  volume,  cloth,  $2.00. 

A  complete  "Treatise  on  Diseases  of  the  Stomach,"  which  bears  testimony  not  only  to  a 
vast  amount  of  work,  but  also  to  a  surprising  research  in  the  literature  of  the  subject.  As  a 
work  of  reft- rence,  we  consider  the  volume  before  us  most  complete,  and  one  which  every  man 
engaged  in  thoroughly  studying  diseases  of  the  stomach  should  consult. — Dublin  Journal  of 
Mud.  Science,  Oct.,  1873. 

This  work,  by  Dr.  AVilson  Fox,  is  a  highly  valuable  one,  representing  very  fully  the  most 
recent  views  relative  to  the  pathology  and  symptomatology  of  diseases  of  the  stomach',  and  oilers 
an  excellent  digest  of  the  principles  and  details  of  treatment  advocated  by  the  most  eminent 
practitioners  of  the  day. — British  and  Foreign  Med.-Chirurg.  Renew,  July,  1873. 

For  want  of  space  we  are  compelled  to  omit  any  notice  of  the  other  subjects  treated  of  in 
this  admirable  work ;  and  in  what  we  have  written  we  have  not  been  able,  for  tin1  same  rea- 
son, to  give  the  author's  remarks  on  the  etiology,  symptoms,  and  diagnosis  of  the  various 
forms  of  dyspepsia,  which  to  the  student  will  prove  the  most  interesting  and  useful  part  of  his 
treatise. — American  Practitioner,  March,  1873. 

We  have  more  than  usual  pleasure  in  calling  attention  to  this  work  by  Dr.  Fox,  as  well 
adapted  to  meet  the  troubles  of  practitioners. —  Cincinnati  Lancet  and  Observer,  March,  1873. 

BRINTON  ON  THE  STOMACH.— Lately  Published. 

LECTURES  ON  THE  DISEASES  OF  THE  STOMACH,  with  an  Introduction  on  its  Anatomy 
and  Physiology.  By  WILLIAM  BRINTON,  M.D.,  F.R.S.,  Physician  to  St.  Thomas's  Hos- 
pital. From  the  second  and  enlarged  London  Edition.  AVith  illustrations  on  wood.  In 
one  handsome  octavo  volume  of  about  300  pages;  extra  cloth,  $3.25. 

This  is  no  mere  compilation,  no  crude  record  of  cases,  but  the  carefully  elaborated  produc- 
tion of  an  accomplished  physician,  who,  for  many  years,  has  devoted  special  attention  to  the 
symptomatology,  pathology,  and  treatment  of  gastric  diseases. — Edinburgh  Medical  Journal. 

FLINT'S  MEDICAL  ESSAYS.— Now  Ready. 

ESSAYS  ON  CONSERVATIVE  MEDICINE,  AND  KINDRED  TOPICS.  By  AUSTIN  FLINT, 
M.D.,  Professor  of  the  Principles  and  Practice  of  Medicine  in  Bellevue  Med.  College,  N.  Y. 
In  one  very  handsome  volume,  royal  12mo. ;  cloth,  $1.38. 

This  little  volume  consists  of  a  c(  llectiou  of  thoughtful  essays  on  important  topics,  which 
have  appeared  from  time  to  time  in  various  periodicals.  The  subjects  treated  of  are  as  follows : 

I.  Conservative  Medicine.  II.  Conservative  Medicine  as  applied  to  Therapeutics.  III.  Con- 
servative Medicine  as  applied  to  Hygiene.  IV.  Medicine  in  the  Past,  the  Present,  and  the 
Future.  V.  Alimentation  in  Disease.  VI.  Tolerance  of  Disease.  VII.  On  the  Agency  of  the 
Mind  in  Etiology,  Prophylaxis,  and  Therapeutics.  VIII.  Divine  Design  as  Manifested  in  the 
Natural  History  of  Diseases. 

A  more  suggestive  collection  of  topics  it  would  be  difficult  to  conceive.  The  essays  on  con- 
servative medicine  are  peculiarly  valuable. — Peninsular  Journal  of  Medicine,  Oct.,  1874. 

TUKE  ON  MENTAL  INFLUENCE.— Lately  Issued. 

ILLUSTRATIONS  OF  THE  INFLUENCE  OF  THE  MIND  UPON  THE  BODY  IN  HEALTH 
AND  DISEASE.  Designed  to  illustrate  the  action  of  the  imagination.  By  DANIKL  HACK 
TUKE,  M.D.,  Joint  author  of  "The  Manual  of  Psychological  Medicine,"  etc".  In  one  hand- 
some octavo  volume  of  416  pages  ;  extra  cloth,  $3.25. 

Dr.  Tuke's  idea  in  writing  this  book  is  to  begin  work  in  this  uninvestigated  field.  It  is  the 
first  work  on  the  subject  extant,  and  practicing  physicians  will  be  am  pry  paid  fur  reading  it 
carefully  through,  and  studying  the  chapter  on  psycho-therapeutics.  Almost  every  physician 
rejects  the  systematic,  scientific  employment  of  psychical  aids  in  curing  disease,  and'in  so  doing 
one  means  is  thrown  away  more  powerful  than  all  the  agents  in  niateria  medica. — Chicago 
Med.  Journal,  Jan.,  1873. 

The  influence  of  the  mind  upon  the  body  is  without  doubt  one  of  the  strongest  therapeutical 
agencies  which  can  be  wielded  by  the  physician,  and  he  who  passes  by  it  as  unworthy  of  bis 
attention,  or  who  uses  it  carelessly  and  in  ignorance  of  its  true  scope  and  value,  is  neglecting 
or  misusing  a  valuable  assistant  in  his  battle  with  disease  and  death.  In  writing  this  book 
the  author  has  placed  the  profession  under  many  obligations  to  him,  and  as  the  subject  is  more 
fully  investigated  as  time  passes  along,  the  reader  of  the  future  will  feel  with  increased  force 
his  debt  of  gratitude  to  Dr.  Tuke  for  placing  in  his  hands  a  work  filled  with  fresh  and  enter- 
taining truths,  stated  in  terms  easily  understood.  We  advise  our  readers  to  obtain  it  and 
study  it  with  care. — Buffalo  Med.  and  Surgical.  Journal,  April,  1873. 

This  book  of  Dr.  Tuke  is  one  of  intense  interest,  not  only  to  the  scientific  man  but  also  to 
the  student  of  the  rational  school  of  metaphysics. — Obstetrical  Journal,  June,  1S73. 


HENRY  C.  LEA,  Philadelphia. 


C.     LEA/S 

(LATE  LEA  A  BLANCHARD'S) 


OF 

MEDICAL  AND  SUEGICAL  PUBLICATIONS, 


In  asking  the  attention  of  the  profession  to  the  works  advertised  in  the  following 
pages,  the  publisher  would  state  that  no  pains  are  spared  to  secure  a  continuance  of 
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The  printed  prices  are  those  at  which  books  can  generally  be  supplied  by  booksellers 
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not  kept  in  stock.  Where  access  to  bookstores  is  not  convenient,  books  will  be  sent 
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money  or  the  books,  and  no  publications  but  ray  own  are  supplied.  Gentlemen  will 
therefore  in  most  cases  find  it  more  convenient  to  deal  with  the  nearest  bookseller. 

An  ILLUSTRATED  CATALOGUE,  of  64  octavo  pages,  handsomely  printed,  will  be  for- 
warded bv  mail,  post-paid,  on  receipt  of  ten  cents. 

HENRY  C.  LEA. 
Nos.  706  and  708  SANSOM  ST.,  PHILADELPHIA,  July,  1875. 


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2          HENRY  C.  LEA'S  PUBLICATIONS — (Am.  Journ.  Med.  Sciences). 

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full  of  varied  and  important  matter,  of  great  interest  to  all  practitioners.  Thus,  during 
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America  continues  to  take  a  great  place  in  this  |  rowed  matter  it  contains,  and  has  established  for 
class  of  journals  (quarterlies),  at  the  head  of  which  '  itself  a  reputation  in  every  country  where  medicine 
the  great  work  of  Dr.  Hays,  the  American  Journal  \  is  cultivated  as  a  science. — Brit,  and  For.  Med.-Chi- 


ofthe  Mecical  Sciences,  still  holds  its  ground,  as  our 
quotations  have  often  proved. — Dublin  Med.  Press 
and  Circular,  Jan.  31,  1872. 

Of  English  periodicals  the  Lancet,  and  of  American 
the  Am.  Journal  of  the  Medical  Sciences,  are  to  be 
regarded  as  necessities  to  the  reading  practitioner. — 
y  Y.  Medical  Gazette,  Jan.  7,  1871. 

The  American  Journal  of  the  Medical  Sciences 


rurg.  Review,  April,  1871. 

This,  if  not  the  best,  is  one  of  the  best-conducted 
medical  quarterlies  in  the  English  language,  and  the 
present  number  is  not  by  any  means  inferior  to  its 
predecessors. — London  Lancet,  Aug.  23,  1873. 

Almost  the  only  one  that  circulates  everywhere, 
all  over  the  Union  and  in  Europe. — London  Medical 
Times,  Sept.  5,  1868. 


yields  to  none  in  the  amount  of  original  and  bor- 

And  that  it  was  specifically  included  in  the  award  of  a  medal  of  merit  to  the  Pub- 
lisher in  the  Vienna  Exhibition  in  1873. 

The  subscription  price  of  the  "AMERICAN  JOURNAL  OF  THE  MEDICAL  SCIENCES"  has 
never  been  raised  during  its  long  career.  It  is  still  FIVE  DOLLARS  per  annum  ;  and 
when  paid  for  in  advance,  the  subscriber  receives  in  addition  the  "MEDICAL  NEWS  AND 
LIBRARY,"  making  in  all  about  1500  large  octavo  pages  per  annum,  free  of  postage. 

II. 

THE  MEDICAL  NEWS  AND  LIBRARY 

is  a  monthly  periodical  of  Thirty-two  large  octavo  pages,  making  384  pages  per 
annum.  Its  "NEWS  DEPARTMENT"  presents  the  current  information  of  the  day,  with 
Clinical  Lectures  and  Hospital  Gleanings;  while  the  ''LIBRARY  DEPARTMENT"  is  de- 
voted to  publishing  standard  works  on  the  various  branches  of  medical  science,  paged 

*  CommunicatiOQS  are  invited  from  gentlemen  in  all  parts  of  the  country.  Elaborate  articles  inserted 
by  the  Editor  are  paid  for  by  the  Publisher. 


HENRY  C.  LEA'S  PUBLICATIONS — (Am.  Journ.  Med.  Sciences).         3 

separately,  so  that  they  can  be  removed  and  bound  on  completion.  In  this  manner 
subscribers  have  received,  without  expense,  such  works  as  "  WATSON'S  PRACTICE," 
"  TODD  AND  BOWMAN'S  PHYSIOLOGY,"  "  WEST  ON  CHILDREN,"  "  MALOAIGNE'S  SUR- 
GERY," &c.  &c.  With  Jan.  1875,  was  commenced  the  publication  of  Dr.  WILLIAM 
STOKES'S  new  work  on  FEVER  (see  p.  14),  rendering  this  a  very  desirable  time  for  new 
subscriptions. 

As  stated  above,  the  subscription  price  of  the  "  MEDICAL  NEWS  AND  LIBRARY"  is 
ONE  DOLLAR  per  annum  in  advance;  and  it  is  furnished  without  charge  to  all  advance 
paying  subscribers  to  the  "AMERICAN  JOURNAL  OF  THE  MEDICAL  SCIENCES." 

III. 

THE  MONTHLY  ABSTRACT  OF  MEDICAL  SCIENCE. 

The  publication  in  England  of  Banking's  "  HALF-YEARLY  ABSTRACT  OF  THE  MEDI- 
CAL SCIENCES"  having  ceased  with  the  volume  for  January,  1874,  its  place  has  been 
supplied  in  this  country  by  a  monthly  "ABSTRACT"  containing  forty-eight  large  octavo 
pages  each  month,  thus  furnishing  in  the  course  of  the  year  about  six  hundred  pages, 
the  same  amount  of  matter  as  heretofore  embraced  in  the  Half-Yearly  Abstract. 
As  the  discontinuance  of  the  "Ranking"  arose  from  the  multiplication  of  journals 
appearing  more  frequently  and  presenting  the  same  character  of  material,  it  has  been 
thought  that  this  plan  of  monthly  issues  will  better  meet  the  wants  of  subscribers, 
who  will  thus  receive  earlier  intelligence  of  the  improvements  and  discoveries  in  the 
medical  sciences.  The  aim  of  the  MONTHLY  ABSTRACT  will  be  to  present  a  careful 
condensation  of  all  that  is  new  and  important  in  the  medical  journalism  of  the  world, 
and  all  the  prominent  professional  periodicals  of  both  hemispheres  will  be  at  the  dis- 
posal of  the  Editors. 

Subscribers  desiring  to  bind  the  ABSTRACT  will  receive,  on  application  at  the  end 
of  each  year,  a  cloth  cover,  gilt  lettered,  for  the  purpose,  or  it  will  be  sent  free  by 
mail  on  receipt  of  the  postage,  which,  under  existing  laws,  will  be  six  cents. 

The  subscription  to  the  "  MONTHLY  ABSTRACT,"  free  of  postage,  is  Two  DOLLARS 
AND  A  HALF  a  year,  in  advance. 

As  stated  above,  however,  it  will  be  supplied  in  conjunction  with  the  "AMERICAN 
JOURNAL  OF  THE  MEDICAN  SCIENCES"  and  the  "MEDICAL  NEWS  AND  LIBRARY,"  making 
in  all  about  TWENTY-ONE  HUNDRED  pages  per  annum,  the  whole  free  of  postage,  for 
Six  DOLLARS  a  year,  in  advance. 

The  first  volume  of  the  "  MONTHLY  ABSTRACT,"  from  July  to  December,  1874,  can 
be  had  by  those  who  desire  to  have  complete  sets,  if  early  application  be  made,  for 
$1  50,  forming  a  handsome  octavo  volume  of  300  pages,  cloth. 

In  this  effort  to  bring  so  large  an  amount  of  practical  information  within  the  reach 
of  every  member  of  the  profession,  the  publisher  confidently  anticipates  the  friendly 
aid  of  ail  who  are  interested  in  the  dissemination  of  sound  medical  literature.  He 
trusts,  especially,  that  the  subscribers  to  the  "AMERICAN  MEDICAL  JOURNAL"  will  call 
the  attention  of  their  acquaintances  to  the  advantages  thus  offered,  and  that  he  will 
be  sustained  in  the  endeavor  to  permanently  establish  medical  periodical  literature 
on  a  footing  of  cheapness  never  heretofore  attempted. 

PREMIUM  POK  NEW  SUBSCKIBEES  'TO  THE  "JOUKNAL." 

Any  gentleman  who  will  remit  the  amount  for  two  subscriptions  for  1875,  one  of 
which  must  be  for  a  neiv  subscriber,  will  receive  as  a  PRF.MIUM,  free  by  mail,  a  copy  of 
"FLINT'S  ESSAYS  ON  CONSERVATIVE  MEDICINE"  (for  advertisement  of  which  see  p.  15), 
or  of  "STURGES'S  CLINICAL  MEDICINE"  (see  p.  14),  or  of  the  new  eduion  of  "SWAYNE'S 
OBSTETRIC  APHORISMS"  (see  p.  24),  or  of  "TANNER'S  CLINICAL  MANUAL"  (see  p.  5), 
or  of  "  CHAMBERS'S  RESTORATIVE  MEDICINE"  (see  p.  16),  or  of  "WEST  ON  NERVOUS 
DISORDERS  OF  CHILDREN"  (see  page  21). 

%*  Gentlemen  desiring  to  avail  themselves  of  the  advantages  thus  offered  will  do 
well  to  forward  their  subscriptions  at  an  early  day,  in  order  to  insure  the  receipt  of 
complete  sets  for  the  year  1875,  as  the  constant  increase  in  the  subscription  list 
almost  always  exhausts  the  quantity  printed  shortly  after  publication. 

$g°  The  safest  mode  of  remittance  is  by  bank  check  or  postal  money  order,  drawn 
to  the  order  of  the  undersigned.  Where  these  are  not  accessible,  remittances  for  the 
"JOURNAL"  may  be  made  at  the  risk  of  the  publisher,  by  forwarding  in  REGISTERED 
letters.  Address, 

HENRY  C.  -LEA, 

Nos.  706  and  708  SANSOM  ST.,  PHILADELPHIA,  PA. 


HENRY  C.  LEA'S  PUBLICATIONS — (Dictionaries). 


flUNGLISON  (ROBLEY],  M.D., 

Late  Professor  of  Institutes  of  Medicine  in  Jefferson  Medical  College,  Philadelphia. 

MEDICAL  LEXICON;  A  DICTIONARY  OF  MEDICAL  SCIENCE:  Con- 
taining a  concise  explanation  of  the  various  Subjects  and  Terms  of  Anatomy,  Physiology, 
Pathology,  Hygiene,  Therapeutics,  Pharmacology,  Pharmacy,  Surgery,  Obstetrics,  Medical 
Jurisprudence,  and  Dentistry.  Notices  of  Climate  and  of  Mineral  Waters ;  Formulae  for 
Officinal,  Empirical,  and  Dietetic  Preparations;  with  the  Accentuation  and  Etymology  of 
the  Terms,  and  the  French  and  other  Synonymes  j  so  as  to  constitute  a  French  as  well  as 
English  Medical  Lexicon.  A  New  Edition.  Thoroughly  Revised,  and  very  greatly  Mod- 
ified and  Augmented.  By  RICHARD  J.  DUNGLISON,  M.D.  In  one  very  large  and  hand- 
some  royal  octavo  volume  of  over  1100  pages.  '  Cloth,  $6  50  ;  leather,  raised  bands,  $7  50. 
(Just  Issued.} 

The  object  of  the  author  from  the  outset  has  not  been  to  make  the  work  a  mere  lexicon  or 
dictionary  of  terms,  but  to  afford,  under  each,  a  condensed  view  of  its  various  medical  relations, 
and  thus  to  render  the  work  an  epitome  of  the  existing  condition  of  medical  science.  Starting 
with  this  view,  the  immense  demand  which  has  existed  for  the  work  has  enabled  him,  in  repeated 
revisions,  to  augment  its  completeness  and  usefulness,  until  at  length  it  has  attained  the  position 
of  a  recognized  and  standard  authority  wherever  the  language  is  spoken. 

Special  pains  have  been  taken  in  the  preparation  of  the  present  edition  to  maintain  this  en- 
viable reputation.  During  the  tt  n  years  which  have  elapsed  since  the  last  revision,  the  additiot  8 
to  the  nomenclature  of  the  medical  sciences  have  been  greater  than  perhaps  in  any  similar  period 
of  the  past,  and  up  to  the  time  of  his  death  the  author  labored  assiduously  to  incorporate  every- 
thing requiring  the  attention  of  the  student  or  practitioner.  Since  then,  the  editor  has  been 
equally  industrious,  so  that  the  additions  to  the  vocabulary  are  more  numerous  than  in  any  pre- 
vious revision.  Especial  attention  has  been  bestowed  on  the  accentuation,  which  will  be  found 
marked  on  every  word.  The  typographical  arrangement  has  been  much  improved,  rendering 
reference  much  more  easy,  and  every  care  has  been  taken  with  the  mechanical  execution.  The 
work  has  been  printed  on  new  type,  small  but  exceedingly  clear,  with  an  enlarged  page,  so  that 
the  additions  have  been  incorporated  with  an  increase  of  but  little  over  a  hundred  pages,  and 
the  volume  now  contains  the  matter  of  at  least  four  ordinary  octavos. 


A  book  well  known  to  our  readers,  and  of  which 
every  American  ought  to  be  proud.  When  the  learned 
author  of  the  work  passed  away,  probably  all  of  us 
feared  lest  the  book  should  not  maintain  its  place 
in  the  advancing  science  whose  terms  it  defines.  For- 
tunately, Dr.  Kichard  J.  Dunglison,  having  assisted  his 
father  in  the  revision  of  several  editions  of  the  work, 
and  having  been,  therefore,  trained  in  the  methods  and 
imbued  with  the  spirit  of  the  book,  has  been  able  to 
edit  it,  not  in  the  patchwork  manner  so  dear  to  the 
lieart  of  book  editors,  so  repulsive  to  the  taste  of  intel- 
ligent book  readers,  but  to  edit  it  as  a  work  of  the  kind 
should  be  edited — to  carry  it  on  steadily,  without  jar 
or  interruption,  along  the  grooves  of  thought  it  has 
travelled  during  its  lifetime.  To  show  the  magnitude 
of  the  task  which  Dr.  Dunplison  has  assumed  and  car- 
ried through,  it  is  only  necessary  to  stale  that  more 
than  six  thousand  new  subjects  have  been  added  in  the 
present  edition.  Without  occupy  ing  more  space  with  the 
theme,  we  congratulate  the  editor  on  the  successful 
eoiupleluin  of  his  labors,  and  hope  he  may  reap  the  well- 
earned  reward  of  profit  and  honor. — Phila.  Med.  Times, 
Jan.  3, 1874. 

About  the  first  book  purchased  by  the  medical  stu- 
dent is  the  Medical  Dictionary.  The  lexicon  explana- 
tory of  technical  terms  is  simply  a  sine  qua  ndn.  In  a 
science  so  extensive,  and  with  such  collaterals  as  medi- 
cine, it  is  as  much  a  necessity  also  to  the  jiracfising 
physician.  To  meet  the  wants  of  students  and  most 
physicians,  the  dictionary  must  be  condensed  while 
comprehensive,  and  practical  while  perspicacious.  It 
was  because  Dunglison's  met  these  indications  that  it 
became  at  once  the  dictionary  of  general  use  wherever 
medicine  was  studied  in  the  English  language.  In  no 
former  revision  have  the  alterations  and  additions  been 
so  great.  More  than  six  thousand  new  subjects  and  terms 
have  been  added.  The  chief  terms  have  been  set  in  black 


We  are  glad  to  see  a  new  edition  of  this  invaluable 
work,  and  to  find  that  it  has  been  so  thoroughly  revised, 
and  so  greatly  improved.  The  dictionary,  in  its  pre- 
sent form,  is  a  medical  library  in  itself,  and  one  of 
which  every  physician  should  be  possessed. — ST.  Y.  Med. 
Journal,  Feb.  1874. 

With  a  history  of  forty  years  of  unexampled  success 
and  universal  indorsement  by  the  medical  profession  of 
the  western  continent,  it  would  be  presumption  in  any 
living  medical  American  to  essay  its  review.  No  re- 
viewer, however  able,  can  add  to  its  fame;  no  captious 
critic,  however  caustic,  can  remove  a  single  stone  from 
its  firm  and  enduring  foundation.  It  is  destined,  as  a 
colossal  monument,  to  perpetuate  the  solid  and  richly 
deserved  fame  of  Kobley  Dunglison  to  coming  genera- 
tions. The  large  additions  made  to  the  vocabulary,  we 
think,  will  be  welcomed  by  the  profession  as  supplying 
the  want  of  a  lexicon  fully  up  with  the  march  of  sci- 
ence, which  has  been  increasingly  felt  for  some  years 
past.  The  accentuation  of  terms  is  very  complete,  and, 
ai-  lar  as  we  have  been  able  to  examine  it,  very  excel- 
lent. We  hope  it  may  be  the  means  of  securing  greater 
uniformity  of  pronunciation  among  medical  men. — At- 
lanta Med.  and  8urg.  Journ.,  Feb.  1874. 

It  would  be  mere  waste  of  words  in  us  to  express 
jur  admiration  of  a  work  which  is  so  universally 
and  deservedly  appreciated.  The  most  admirable 
work  of  its  kind  in  the  English  language. —  Gflasgow 
Medical  Journal,  January,  1866. 

A  work  to  which  there  is  no  equal  in  the  English 
language. — Edinburgh  Medical  Journal. 

Few  works  of  the  class  exhibit  a  grander  monument 
jf  patient  research  and  of  scientific  lore.  The  extent 
jf  the  sale  of  this  lexicon  is  sufficient  to  testify  to  its 


asefniness,  and  to  the  great  service  conferred  by  Dr. 


letter,  while  ihe  derivatives  follow  in  small  caps;  an  !  Robley  Dunglison  on  the  profession,  and -indeed  on 


arrangement  which  greatly  facilitates  reference.  We 
may  safely  confirm  the  hope  ventured  by  the  editor 
'•  that  the  work,  which  possesses  for  him  a  filial  as  well 
as  an  individual  interest,  will  be  found  worthy  a  con- 


jthers,  by  its  issue. — London  Lancet,  May  13,  1866. 

It  has  the  rare  merit  that  it  certainly  has  no  rival 
in  the  English  language  for  accuracy  and  extent  of 


as  an   niv  n,  -  V .  • 

tinuance  of  "the  position  so  long  accorded  to  it  as  a  |  references.—  London  Medical  Gazette. 
standard  authority." — Cincinnati  Clinic,  Jan.  10,  1874.  | 


LJOBLYN  (RICHARD  D.),  M.D. 

A  DICTIONARY  OF  THE  TERMS  USED  IN  MEDICINE  AND 

THE  COLLATERAL  SCIENCES.     Revised,  with  numerous  additions,  by  ISAAC    HATS, 
M.D.,  Editor  of  the  "American  Journal  of  the  Medical  Sciences."     In  one  large  royal 
12mo.  volume  of  over  500  double-columned  pages;  cloth,  $1  50  ;  leather,  $2  00. 
It  is  the  best  book  of  definitions  we  have,  and  ought  always  to  be  apon  the  «tndent'»  table.—  Southern 
lied,  and  Sury.  Journal. 


HENRY  C.  LEA'S  PUBLICATIONS — (Manuals). 


KTEILL  (JOHN),  M.D.,    and     &MITH  (FRANCIS  O.),  M.D., 

Prof.of  the  Institutes  of  Medicine  in  the  Univ.  of  Penna. 

AN   ANALYTICAL    COMPENDIUM   OP   THE   VARIOUS 

BRANCHES  OP  MEDICAL  SCIENCE  ;  for  the  Use  and  Examination  of  Students.     A 

new  edition,  revised  and  improved.    In  one  very  large  and  handsomely  printed  royal  12mo. 

volume,  of  about  one  thousand  pages,  with  374  wood  cuts,  cloth,  $4;  strongly  bound  in 

leather,  with  raised  bands,  $4  75. 

The  Compend  of  Drs.  Neilland  Smith  is  incompara- :  clous  factstreasnred  np  In  this  little  volume.    Acorn- 
biy  the  most  valuable  work  of  its  class  ever  published  i  plete  portable  library  so  condensed  that  the  student 
In  this  country.   Attempts  have  been  made  in  various  (  may  make  it  his  constant  pocket  companion. —  West- 
quarters  to  squeeze  Anatomy,  Physiology,  Surgery,    wn.  Lancet. 
the  Practice  of  Medicine,  Obstetrics  Materia  Medica,  |     In  the  rapld  course  of  lectures,  where  work  for  the 


admirably  drawn  and  illustrated,  and  the  authors  .  of  the  kind  that  we  knowof.  Of  course  it  is  useless 
are  eminently  entitled  to  the  grateful  consideration  for  U8  to  recommend  it  toalllastcoursestndents  bnt 
of  the  student  of  every  class.— N.  0.  Med.  and  Surg.  there  ls  ft  cla(Ig  to  wnom  we  very  8incerely  commend 
Journal,.  tnis  cheap  book  as  worth  Us  weight  in  silver— th»t 

There  are  but  few  students  or  practitioners  of  me-  class  is  the  graduates  in  medicine  of  more  than  tea 
dicine  unacquainted  with  the  former  editions  of  this  ;  years'  standing,  who  have  not  studied  medicine 
unassuming  though  highly  instructive  work.  The  since.  They  will  perhaps  find  out  from  it  that  the 
whole  science  of  medicine  appears  to  have  been  sifted,  i  science  is  not  exactly  now  what  It  was  when  they 
as  the  gold-bearing  sands  of  El  Dorado,  and  the  pre- 1  left  it  off. — The  Stethoscope. 


TJARTSHORNE  [HENRY],  M.  D., 

Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

A   CONSPECTUS    OF   THE    MEDICAL   SCIENCES;   containing 

Handbooks  on  Anatomy,  Physiology,  Chemistry,  Materia  Medica,  Practical  Medicine^ 
Surgery,  and  Obstetrics.  Second  Edition,  thoroughly  revised  and  improved.  In  one  large 
royal  12mo.  volume  of  more  than  1000  closely  printed  pages,  with  477  illustrations  on 
wood.  Cloth,  $4  25  ;  leather,  $5  00.  (Lately  Issued.) 

The  favor  with  which  this  work  has  been  received  has  stimulated  the  author  in  its  revision  to 
render  it  in  every  way  fitted  to  meet  the  wants  of  the  student,  or  of  the  practitioner  desirous  to 
refresh  his  acquaintance  with  the  various  departments  of  medical  science.  The  various  sections  have 
been  brought  up  to  a  level  with  the  existing  knowledge  of  the  day,  while  preserving  the  condensa- 
tion of  form  by  which  so  vast  an  accumulation  of  facts  have  been  brought  within  so  narrow  a 
compass.  The  series  of  illustrations  has  been  much  improved,  while  by  the  use  of  a  smaller  type 
the  additions  have  been  incorporated  without  increasing  unduly  the  size  of  the  volume. 

The  work  before  us  has  already  successfully  assert- i  and  the  clear  and  instructive  illustrations  in  some 
ed  its  claim  to  the  confidence  and  favor  of  the  profes-  parts  of  the  work. — American  Journ.  of  Pharmacy, 
sion  ;  it  but  remains  for  us  to  say  that  in  the  present  !  Philadelphia,  July,  1S74. 

edition  the  whole  work  has  been  fully  overhauled  The  vo,ume  win  be  found  nsefnl  not  only  to  8tn. 
and  brought  up  to  the  present  status  of  the  science.—  j  dea(8i  b(U  to  manyothers  who  may  desire  to  refresh 
Atlanta  Med.  and  Surg.  Journal,  Sept.  1874.  their  memories  with  the  smallest  possible  expendi- 


The  work  is  intended  as  an  aid  to  the  me.dical  stu- 
dout,  aud  an  such  appears  to  admirably  fulfil  its  ob- 


ture  of  time.— A".  Y.  Jfed.  Journal,  Sept.  1874. 
The  student  will  find  this  the  most  convenient  and 
he  can  lay  his 
ra.,  Aug.  1S74. 


ject  by  its  excellent  arrangement,  the  full  compilation     useful  book  of  the  kind  on  which 
of  facts,  the  perspicuity  aud  terseness  of  language,  i  hand. — Pacific  Med.  and  Surg.  Jou 

f  ODLOW  (J.L.),  M.D. 

A   MANUAL   OP   EXAMINATIONS   upon  Anatomy,  Physiology, 

Surgery,  Practice  of  Medicine,  Obstetrics,  Materia  Medica,  Chemistry,  Pharmacy,  and 
Therapeutics.  To  which  is  added  a  Medical  Formulary.  Third  edition,  thoroughly  revised 
and  greatly  extended  and  enlarged.  With  370  illustrations.  In  one  handsome  royal 
12mo.  volume  of  816  large  pages,  cloth,  $3  25 ;  leather,  $3  75. 

The  arrangement  of  this  volume  in  the  form  of  question  and  answer  renders  it  especially  suit- 
able for  the  office  examination  of  students,  and  for  those  preparing  for  graduation. 


WANNER  (THOMAS  HAWKES),  M.D.,  &c. 

A  MANUAL  OF  CLINICAL  MEDICINE  AND  PHYSICAL  DIAG- 

NOSIS.  Third  American  from  the  Second  London  Edition.  Revised  and  Enlarged  by 
TILBURY  Fox,  M.  D.,  Physician  to  the  Skin  Department  in  University  College  Hospital, 
Ac.  In  one  neat  volume  small  12mo.,  of  about  375  pages,  cloth,  $150. 

***  By  reference  to  the  "  Prospectus  of  Journal"  on  page  3,  it  will  be  seen  that  this  work  is 
offered  as  a  premium  for  procuring  new  subscribers  to  the  "AMERICAN  JOURNAL  OP  THE  MEDICAL 
SCIENCES." 

Taken  as  a  whole,  it  is  the  most  compact  vade  me-  j  The  objections  commonly,  and  Jnstly,  urged  against 
cum  for  the  use  of  the  advanced  student  and  junior  ( the  general  run  of  "compends,"  "conspectuses,"  and 
practitioner  with  which  we  are  acquainted. — Boston  other  aids  to  indolence,  are  not  applicable  to  this  little 
Iftd.  and  Surg.  Journal,  Sept.  22,  1870.  >  volume,  which  contains  in  concise  phrase  just  those 

practical  details  that  are  of  most  use  in  daily  diag- 

It  contains  so  much  that  is  valuable,  presented  in  :  nosis,  but  which  the  young  practitioner  finds  it  diffl- 
so  attractive  a  form,  that  it  can  hardly  be  spared  cult  to  carry  always  in  his  memory  without  some 
even  in  the  presence  of  more  full  and  complete  works.  ,  quickly  accessible  means  of  reference.  Altogether, 
Its  convenient  size  makes  it  a  valuable  companion  the  book  is  one  which  we  can  heartily  commend  to 
to  the  country  practitioner,  and  if  constantly  car-  those  who  have  not  opportunity  for  extensive  read- 


ried  by  him,  would  often  render  him  good  service, 
and  relieve  many  a  doubt  and  perplexity.—  Leaven- 


ing,  or  who,  having  read  much,  still  wish  an  occa- 
sional practical  reminder. — K.  T.  Ned.  Gazette,  NOT. 


10  1S70. 


HENRY  C.  LEA'S  PUBLICATIONS — (Anatomy}. 


QRAY  (HENRY),  F.R.S., 

Lecturer  on  Anatomy  at  St.  George's  Hospital,  London. 

ANATOMY,   DESCRIPTIVE    AND    SURGICAL.      The  Drawings  by 

H.  V.  CARTER,  M.  D.,  late  Demonstrator  on  Anatomy  at  St.  George's  Hospital;  the  Dissec- 
tions jointly  by  the  AUTHOR  and  DR.  CARTER.  A  new  American,  from  the  fifth  enlarged 
and  improved  London  edition.  In  one  magnificent  imperial  octavo  volume,  of  nearly  908 
pages,  with  465  large  and  elaborate  engravings  on  wood.  Price  in  cloth,  $6  00  ;  lea- 
ther, raised  bands,  $7  00.  (Just  Issued!) 

The  author  has  endeavored  in  this  work  to  cover  a  more  extended  range  of  subjects  than  is  cus- 
tomary in  the  ordinary  text-books,  by  giving  not  only  the  details  necessary  for  the  student,  but 
also  the  application  of  those  details  in  the  practice  of  medicine  and  surgery,  thus  rendering  it  boti 
a  guide  for  the  learner,  and  an  admirable  work  of  reference  for  the  active  practitioner.  The  en  • 
gravings  form  a  special  feature  in  the  work,  many  of  them  being  the  size  of  nature,  nearly  all 
original,  and  having  the  names  of  the  various  parts  printed  on  the  body  of  the  cut,  in  place  of 
figures  of  reference,  with  descriptions  at  the  foot.  They  thus  form  a  complete  and  splendid  series, 
which  will  greatly  assist  the  student  in  obtaining  a  clear  idea  of  Anatomy,  and  will  also  serve  to 
refresh  the  memory  of  those  who  may  find  in  the  exigencies  of  practice  the  necessity  of  recalling 
the  details  of  the  dissecting  room;  while  combining,  as  it  does,  a  complete  Atlas  of  Anatomy,  with 
a  thorough  treatise  on  systematic,  descriptive,  and  applied  Anatomy,  the  work  will  be  found  of 
essential  use  to  all  physicians  who  receive  students  in  their  offices,  relieving  both  preceptor  and 
pupil  of  much  labor  in  laying  the  groundwork  of  a  thorough  medical  education. 

Notwithstanding  the  enlargement  of  this  edition,  it  has  been  kept  at  its  former  very  moderate 
price,  rendering  it  one  of  the  cheapest  works  now  before  the  profession. 

The  illustrations  are  beautifully  executed,  and  ren- 1      From  time  to  time,  as  successive  editions  have  ap- 
der  this  work  an  indispensable  adjunct  to  the  library  I  peared,  we  have  had  much   pleasure  in  expressing 
of  the  surgeon.    This  remark  applies  with  great  force  j  the  general  judgment  of  the  wonderful  excellence  of 
to  those  surgeons  practising  at  a  distance  from  onr    Gray's  Anatomy. — Cincinnati  Lancet,  Jaly,  1870. 
large  cities,  as  the  opportunity  of  refreshing  their        Altogether,  it  is  unquestionably  the  most  complete 


memjory  by  actual  dissection  is  not  always  attain- 
able.— Canada  Mtd.  Journal,  Ang.  1870. 

The  work  is  too  well  known  and  appreciated  by  the 
profession  to  need  any  comment.  No  medical  man 
can  afford  to  be  without  it,  if  its  only  merit  were  to 
serve  as  a  reminder  of  that  which  so  soon  becomes 
forgotten,  when  not  called  into  frequent  use,  viz.,  the 
relations  and  names  of  the  complex  organism  of  the 
human  body.  The  present  edition  is  much  improved. 
— California  Ned.  Gazette,  July,  1870. 

Gray's  Anatomy  has  been  so  long  the  standard  of 
perfection  with  every  student  of  anatomy,  that  we 


and  serviceable  text-book  in  anatomy  that  has  ever 
been  presented  to  the  student,  and  forms  a  atrikiug 
contrast  to  the  dry  and  perplexing  volumes  on  the 
same  subject  through  which  their  predecessors  strug- 
gled in  days  gone  by. — N.  T.  Med.  Record,  June  15, 
1870. 

To  commend  Gray's  Anatomy  to  the  medical  pro- 
fession is  almost  as  much  a  work  of  supererogation 
as  it  would  be  to  give  a  favorable  notice  of  the  Bibl* 
in  the  religious  press.  To  say  that  it  is  the  most 
complete  and  conveniently  arranged  text-book  of  it* 
kind,  is  to  repeat  what  each  generation  of  students 


need  do  no  more  than  call  attention  to  the  improve-  I  has  learned  as  a  tradition  of  thf>  elders,  and  verified 
ment  in  the  present  edition. — Detroit  Review  of  Med.  by  personal  experience. — N  Y.  Med.  Gazette,  Dec. 
and  Pharm.,  Aug.  1870.  17, 1870. 

<3MITH  (HENRY H.),  M.D.,         and     TJORNER  (  WILLIAM  E.),  M.D., 

Prof,  of  Surgery  in  the  Univ.  o/Penna.,Ac.  Late  Prof .  of  Anatomy  in  the  Univ.ofPenna.,&c. 

AN    ANATOMICAL    ATLAS,  illustrative  of  the   Structure  of  the 

Human  Body.     In  one  volume,  large  imperial  octavo,  cloth,  with  about  six  hundred  and 
fifty  beautiful  figures.     $4  50. 


VHARPEY  (  WILLIAM),  M.D.,     and       Q  UAIN  (JONES  fr  RICHARD). 
HUMAN  ANATOMY.  Revised,  with  Notes  and  Additions,  by  JOSEPH 

LEIDY,  M.D.,  Professor  of  Anatomy  in  the  University  of  Pennsylvania.     Complete  in  two 
large  octavo  volumes,  of  about  1300  pages,  with  511  illustrations;  cloth,  $6  00. 
The  very  low  price  of  this  standard  work,  and  its  completeness  in  all  departments  of  the  subject, 
should  command  for  it  a  place  in  the  library  of  all  anatomical  students. 

fTODGES  (RICHARD  M.),  M.D., 

Late  Demonstrator  of  Anatomy  in  the  Medical  Department  of  Harvard  University. 

PRACTICAL  DISSECTIONS.     Second  Edition,  thoroughly  revised.     In 

one  neat  royal  12mo.  volume,  half-bound,  $2  00. 

The  object  of  this  work  is  to  present  to  the  anatomical  student  a  clear  and  concise  description 
of  that  which  he  is  expected  to  observe  in  an  ordinary  couise  of  dissections.  The  author  has 
endeavored  to  omit  unnecessary  details,  and  10  present  the  subjest  in  the  form  which  many  years' 
experience  has  shown  him  to  be  the  most  convenient  and  intelligible  to  the  student.  In  the 
rsvision  of  the  present  edition,  he  has  sedulously  labored  to  render  the  volume  more  worthy  of 
the  favor  with  which  it  has  heretofore  been  received. 


HORNER'S  SPECIAL  ANATOMY  AND  HISTOLOGY.  I      In  2  vols.  8vo.,  of  over  1000  pages,  with  more  than 
Eighth  edition,  extensively  revised  and  modified.  I     300  wood-cuts;  cloth,  *6  00 


HENRY  C.  LEA'S  PUBLICATIONS — (Anatomy). 


WILSON  (ERASMUS),  F.E.S. 

A  SYSTEM  OF  HUMAN  ANATOMY,  General  and  Special.    Edited 

by  W.  H.  QOBKECHT,  M.  D.,  Professor  of  Qeneraland  Surgical  Anatomy  in  the  Medical  Col- 
lege of  Ohio.  Illustrated  with  three  hundred  and  ninety-seven  engravings  on  wood.  In 
one  large  and  handsome  octavo  volume,  of  over  600  large  pages ;  cloth,  $4  00 ;  leather, 
$5  00. 

The  publisher  trusts  that  the  well-earned  reputation  of  this  long-established  favorite  will  be 
more  than  maintained  by  the  present  edition.  Besides  a  very  thorough  revision  by  the  author,  it 
has  been  most  carefully  examined  by  the  editor,  and  the  efforts  of  both  have  been  directed  to  in- 
troducing everything  which  increased  experience  in  its  use  has  suggested  as  desirable  to  render  it 
a  complete  text-book  for  those  seeking  to  obtain  or  to  renew  an  acquaintance  with  Human  Ana- 
tomy. The  amount  of  additions  which  it  has  thus  received  may  be  estimated  from  the  fact  that 
the  present  edition  contains  over  one-fourth  more  matter  than  the  last,  rendering  a  smaller  type 
and  an  enlarged  page  requisite  to  keep  the  volume  within  a  convenient  size.  The  author  has  not 
only  thus  added  largely  to  the  work,  but  he  has  also  made  alterations  throughout,  wherever  there 
appeared  the  opportunity  of  improving  the  arrangement  or  style,  so  as  to  present  every  fact  in  ita 
most  appropriate  manner,  and  to  render  the  whole  as  clear  and  intelligible  ad  possible.  The  editor 
has  exercised  the  utmost  caution  to  obtain  entire  accuracy  in  the  text,  and  has  largely  increased 
the  number  of  illustrations,  of  which  there  are  about  one  hundred  and  fifty  more  in  this  edition 
than  in  the  last,  thus  bringing  distinctly  before  the  eye  of  the  student  everything  of  interest  or 
importance. 

fJEATH  (CHRISTOPHER),  F.R.  C.  S., 

«*-*•  Teacher  of  Operative  Surgery  in  University  College,  London. 

PRACTICAL  ANATOMY:   A  Manual  of  Dissections.     From  the 

Second  revised  and  improved  London  edition.  Edited,  with  additions,  by  W.  W.  KEEN, 
M.  D.,  Lecturer  on  Pathological  Anatomy  in  the  Jefferson  Medical  College,  Philadelphia. 
In  one  handsome  royal  12mo.  volume  of  578  pages,  with  247  illustrations.  Cloth,  $3  50  ; 
leather,  $4  00.  (Lately  Publislied.) 


Dr.  Keen,  the  American  editor  of  this  work,  in  his 
preface,  says  :  "  In  presenting  this  American  edition 
of  'Heath's  Practical  Anatomy,'  I  feel  that  I  have 
been  instrumental  in  supplying  a  want  long  felt  for 
a  real  dissector's  manual,"  and  this  assertion  of  its 
editor  we  deem  is  fully  justified,  after  an  examina- 
tion of  its  contents,  for  it  is  really  an  excellent  work. 
Indeed,  we  do  not  hesitate  to  say,  the  best  of  its  class 
with  which  we  are  acquainted  ;  resembling  Wilson 
In  terse  and  clear  description,  excelling  most  of  the 
so-called  practical  anatomical  dissectors  in  the  scope 
of  the  subject  and  practical  selected  matter.  .  .  . 
In  reading  this  work,  one  is  forcibly  impressed  with 
the  great  pains  the  author  takes  to  impress  the  sub- 
ject upon  the  mind  of  the  student.  He  is  full  of  rare 
and  pleasing  little  devices  to  aid  memory  in  main- 


taining its  hold  upon  the  slippery  slopes  of  anatomy. 
— St.  Louis  Med.  and  Surg.  Journal,  Mar.  10,  1871. 

It  appears  to  us  certain  that,  as  a  guide  in  dissec- 
tion, and  as  a  work  containing  facts  of  anatomy  in 
brief  and  easily  understood  form,  this  manual  is 
complete.  This  work  contains,  also,  very  perfect 
illustrations  of  parts  which  can  thus  be  more  easily 
anderstood  and  studied;  in  this  respect  it  compares 
'avorably  with  works  of  much  greater  pretension. 
Such  manuals  of  anatomy  are  always  favorite  works 
with  medical  students.  We  would  earnestly  recom- 
mend this  one  to  their  attention ;  it  has  excellences 
which  make  it  valuable  as  a  guide  in  dissecting,  as 
well  as  in  studying  anatomy. — Buffalo  Medical  and 
SurfficalJournal,  Jan.  1871. 


BELLAMY  (E.),  F.R.C.S. 

THE  STUDENT'S  GUIDE  TO  SURGICAL  ANATOMY:  A  Text- 

Book  for  Students  preparing  for  their  Pass  Examination.    With  engravings  on  wood.    In 
one  handsome  royal  12mo.  volume.     Cloth,  $2  25.     (Just  Issued.) 

We  cannot  too  highly  recommend  it. — Student's 
Journal. 

Mr.  Bellamy  has  spared  no  pains  to  produce  a  real- 
ly reliable  student's  guide  to  surgical  anatomy — one 
which  all  candidates  for  surgical  degrees  may  con- 
ult  with  advantage,  and  which  posseses  much  ori- 


We  welcome  Mr.  Bellamy's  work,  as  a  contribu- 
tion to  the  study  of  regional  anatomy,  of  equal  value 
to  the  student  and  the  surgeon.  It  is  written  in  a 
clear  and  concise  style,  and  its  practical  suggestions 
add  largely  to  the  interest  attaching  to  its  technical 
details  — (Jhicago  Med.  Examiner,  March  1,  1874. 

We  cordially  congratulate  Mr.  Bellamy  upon  hav- 
ing produced  it. — Med.  Times  and  Gaz. 


ginal  matter. — Med.  Press  and  Circular. 


1MACLISE  (JOSEPH). 

SURGICAL  ANATOMY.     By  JOSEPH  MACLISE,  Surgeon.    In  one 

volume,  very  large  imperial  quarto ;  with  68  large  and  splendid  plates,  drawn  in  the  best 
style  and  beautifully  colored,  containing  190  figures,  many  of  them  the  size  of  life;  together 
with  copious-  explanatory  letter-press.  Strongly  and  handsomely  bound  in  cloth.  Price 
$14  00. 

We  know  of  no  work  on  surgical  anatomy  which 
•an  compete  with  it. — Lancet. 

The  work  of  Maclise  on  surgical  anatomy  is  of  the 
highest  value.  In  some  respects  it  is  the  best  publi- 
cation of  its  kind  we  have  seen,  and  is  worthy  of  a 
place  in  the  libiary  of  any  medical  man,  while  the 
student  could  scarcely  make  a  better  investment  than 
this.  —  The  Western  Journal  of  Medicine  and  Surgery. 
No  such  lithographic  illustrations  of  surgical  re- 


have  hitherto,  we  think,  been  given.    While 


,  ,  . 

hown  every  vessel  and  nerve  where 


o    enusasm.         e    ng  que 

exhausted  the  words  of  praise,  in  recommending  this 
admirable  treatise.  —  Boston  Med.  and  Surg.  Journ. 


fJA R TSHORNE  (HENR Y),  M.D., 

•*--*-  Professor  of  Hygiene,  etc  ,  in  the  Univ.  ofPenna. 

HANDBOOK  OF   ANATOMY  AND   PHYSIOLOGY.     Second  Edi- 
tion, revised.   In  one  royal  12ino.  volume,  with  220  wood-cuts ;  cloth,  $1  75.   ( Just  Issued.) 


HENRY  C.  LEA'S  PUBLICATIONS — (Physiology). 


MARSHALL  (JOHN),  F.  E.  S., 

J.U.  Professor  of  Surgery  in  University  College,  London,  Ac. 

OUTLINES  OF  PHYSIOLOGY,  HITMAN  AND  COMPARATIVE. 

With  Additions  by  FRANCIS  GURNET  SMITH,  M.  D.,  Professor  of  the  Institutes  of  Medi- 
cine in  the  University  of  Pennsylvania,  Ac.  With  numerous  illustrations.  In  one  large 
and  handsome  octavo  volume,  of  1026  pages,  cloth,  $6  50  ;  leather,  raised  bands,  $7  50. 


In  fact,  in  every  respect,  Mr.  Marshall  has  present- 
Ad  us  with  a  most  complete,  reliable,  and  scientific 
Work,  and  we  feel  that  it  is  worthy  our  warmest 
commendation. — St.  Louis  Ned.  Reporter,  Jan.  1869. 

We  doubt  if  there  is  in  the  English  language  any 
compend  of  physiology  more  useful  to  the  student 
than  this  work. — St.  Louis  Med.  and  Surg.  Journal, 
Jan.  1869. 

It  quite  fulfils,  in,  our  opinion,  the  author's  design 
of  making  it  truly  educational  in  its  character— which 
Is,  perhaps,  the  highest  commendation  that  can  be 
asked. — Am.  Journ.  Med.  Sciences,  Jaii.  1869. 

We  may  now  congratulate  him  on  having  com- 
pleted the  latest  as  well  as  the  best  summary  of  mod- 
ern physiological  science,  both  human  and  compara- 


tive, with  which  we  are  acquainted.     To  speak  o< 
this  work  in  the  terms  ordinarily  used  on  such  occa- 

•  sions  would  not  be  agreeable  to  ourselves,  and  would 
!  fail  to  do  justice  to  its  author.     To  write  such  a  book 
(  requires  a  varied  and  wide  range  of  knowledge,  con- 
siderable power  of  analysis,  correct  judgment,  skill 
in  arrangement,  and  conscientious  spirit. — London 

j  Lancet,  Feb.  22,  1868. 

l  There  arefew,  ifany,  more  accomplished  anatomists 
'  and  physiologists  than  the  distinguished  professor  of 
;  surgery  at  University  College  ;  and  he  has  long  en- 
j  joyed  the  highest  reputation  as  a  teacher  of  physiol- 

*  ogy,  possessing  remarkable  powers  of  clearexposition 
and  graphic  illustration.     We  have  rarely  the  plea- 
sure of  being  able  to  recommend  a  text-book  so  unre- 
servedlyasthis. — British  Med.  Journal,  Jar. 25,1868. 


rtARPENTER  (WILLIAM  B.),  M.D.,  F.R.S., 

v  Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  appli- 
cations to  Psychology,  Pathology,  Therapeutics,  Hygiene  and  Forensic  Medicine.  A  new 
American  from  the  last  and  revised  London  edition.  With  nearly  three  hundred  illustrations. 
Edited,  with  additions,  by  FRANCIS  GURNET  SMITH,  M.  D.,  Professor  of  the  Institutes  of 
Medicine  in  the  University  of  Pennsylvania,  Ac.  In  one  very  large  and  beautiful  octavo 
volume,  of  about  900  large  pages,  handsomely  printed;  cloth,  $5  50  ;  leather,  raised  bands, 
$6  50. 

We  doubt  not  it  is  destined  to  retain  a  strong  hold 


With  Dr.  Smith,  we  confidently  believe  "that  the 
present  will  more  than  sustain  the  enviable  reputa- 
tion already  attained  by  former  editions,  of  being 
one  of  the  fullest  and  most  complete  treatises  on  the 
subject  in  the  English  language."  We  know  of  none 
from  the  pages  of  which  a  satisfactory  knowledge  of 
the  physiology  of  the  human  organism  can  be  as  well 
obtained,  none  better  adapted  for  the  use  of  such  as 
take  up  the  study  of  physiology  in  its  reference  to 
the  institutes  and  practice  of  medicine. — Am.  Jour. 
Sled.  Sciences. 


on  public  favor,  and  remain  the  favorite  text-book  in 
our  colleges. — Virginia  Medical  Journal. 

'  The  above  is  the  title  of  what  ig  emphatically  the 
great  work  on  physiology ;  and  we  are  conscious  that 
it  would  be  a  useless  effort  to  attempt  to  add  any- 
thing to  the  reputation  of  this  invaluable  work,  and 
can  only  say  to  all  with  whom  our  opinion  has  any 
influence,  that  it  is  our  authority. — Atlanta  Med. 
Journal. 


DF  THE  SAME  AUTHOR. 

PRINCIPLES  OF  COMPARATIVE  PHYSIOLOGY.    New  Ameri- 

can,  from  the  Fourth  and  Revised  London  Edition.     In  one  large  and  handsome  octavo 
volume,  with  over  three  hundred  beautiful  illustrations .    Pp.  752.    Cloth,  $5  00. 
As  a  complete  and  condensed  treatise  on  its  extended  and  important  subject,  this  work  becomes 

a  necessity  to  students  of  natural  science,  while  the  very  low  price  at  which  it  is  offered  places  it 

within  the  reach  of  all. 


JTIRKES  (  WILLIAM  SENHOUSE),  M.D. 

A  MANUAL  OF  PHYSIOLOGY.     Edited  by  W.  MOEEANT  BAKER, 

M.D.,  F.R.C.S.  A  new  American  from  the  eighth  and  improved  London  edition.  With 
about  two  hundred  and  fifty  illustrations.  In  one  large  and  handsome  royal  12mo.  vol- 
ume. Cloth,  $3  25;  leather,  $3  75.  (Lately  Issued.) 

Kirkes'  Physiology  has  long  been  known  as  a  concise  and  exceedingly  convenient  text-book, 
presenting  within  a  narrow  compass  all  that  is  important  for  the  student.  The  rapidity  with 
which  successive  editions  have  followed  each  other  in  England  has  enabled  the  editor  to  keep  it 
thoroughly  on  a  level  with  the  changes  and  new  discoveries  made  in  the  science,  and  the  eighth 
edition,  of  which  the  present  is  a  reprint,  has  appeared  so  recently  that  it  may  be  regarded  as 
the  latest  accessible  exposition  of  the  subject.  is^ui 


On  the  whole,  there  is  very  little  in  the  book 
which  either  the  student  or  practitioner  will  not  find 
of  practical  value  and  consistent  with  our  present 
knowledge  of  this  rapidly  changing  science  ;  and  we 
have  no  hesitation  in  expressing  our  opinion  that 
this  eighth  edition  is  one  of  the  best  handbooks  on 
.physiology  which  we  have  in  our  language. — N.  Y. 
Med.  Record,  April  15,  1873. 

This  volume  might  well  be  used  to  replace  many 
of  the  physiological  text-books  in  use  in  this  coun- 
try. It  represents  more  accurately  than  the  works 
of  Dalton  or  Flint,  the  present  state  of  our  knowl- 
edge of  most  physiological  questions,  while  it  is 
much  less  bulky  and  far  more  readable  than  the  lar- 


ger text-books  of  Carpenter  or  Marshall.  The  book 
is  admirably  adapted  to  be  placed  in  the  hands  of 
students. — Boston  Med.  and  Surg.  Journ.,  April  10, 
1873. 

In  its  enlarged  form  it  is,  in  our  opinion,  still  the 
best  book  on  physiology,  most  useful  to  the  student. 
— Phil  a.  Med.  Times,  Aug.  30,  1873. 

This  is  undoubtedly  the  best  work  for  students  of 
physiology  extant. — Cincinnati  Med.  News,  Sept.  '73. 

It  more  nearly  represents  the  present  condition  of 
physiology  than  any  other  text-book  on  the  subject.— 
Detroit  Rev.  of  Med.  Pharm.,  Nov.  1873. 


HENRY  C.  LEA'S  PUBLICATIONS — (Physiology). 


f)  ALTON  (J.  C.),  M.D., 

•*-'  Professor  of  Physiology  in  the  College  of  Physicians  and  Surgeons,  Few  York,  Ac. 

A  TREATISE  ON  HUMAN  PHYSIOLOGY.   Designed  for  the  use 

of  Students  and  Practitioners  of  Medicine.  Fifth  edition,  revised,  with  nearly  three  hun- 
dred illustrations  on  wood.  In  one  very  beautiful  octavo  volume,  of  over  700  pages,  cloth, 
$5  25  ;  leather,  $6  25. 

Preface  to  the  Fifth  Edition. 

In  preparing  the  present  edition  of  this  work,  the  general  plan  and  arrangement  of  the  previous 
editions  have  been  retained,  so  far  as  they  have  been  found  useful  and  adapted  to  the  purposes  uf 
&  text-book  for  students  of  medicine.  The  incessant  advance  of  all  the  natural  and  physical 
sciences,  never  more  active  than  within  the  last  five  years,  has  furnished  many  valuable  aids  to 
the  special  investigations  of  the  physiologist ;  and  the  progress  of  physiological  research,  during 
the  same  period,  has  required  a  careful  revision  of  the  entire  work,  and  the  modification  or  re- 
arrangement of  many  of  its  parts.  At  this 'day,  nothing  is  regarded  as  of  any  value  in  natural 
science  which  is  not  based  upon  direct  and  intelligible  observation  or  experiment;  and,  accord- 
ingly, the  discussion  of  doubtful  or  theoretical  questions  has  been  avoided,  as  a  general  rule,  in 
the  present  volume,  while  new  facts,  from  whatever  source,  if  fully  established,  have  been  added 
and  incorporated  with  the  results  of  previous  investigation.  A  number  of  new  illustrations  have 
been  introduced,  and  a  few  of  the  older  ones,  which  seemed  to  be  no  longer  useful,  have  been 
omitted.  In  all  the  changes  and  additions  thus  made,  it  has  been  the  aim  of  the  writer  to  make  the 
book,  in  its  present  form,  a  faithful  exponent  of  the  actual  conditions  of  physiological  science. 
WEW  YORK,  October,  1871. 

In  this,  the  standard  text-book  on  Physiology,  all  that  is  needed  to  maintain  the  favor  with  which 
it  is  regarded  by  the  profession,  is  the  author's  assurance  that  it  has  been  thoroughly  revised  and 
brought  up  to  a  level  with  the  advanced  science  of  the  day.  To  accomplish  this  has  required 
some  enlargement  of  the  work,  but  no  advance  has  been  made  in  the  price. 


The  fifth  edition  of  this  truly  valuable  work  on 
Human  Physiology  comes  to  us  with  many  valuable 
Improvements  and  additions.  As  a  text-book  of 
physiology  the  work  of  Prof.  Dalton  has  long  been 
well  known  as  one  of  the  best  which  could  be  placed 
tu  the  hands  of  student  or  practitioner.  Prof.  Dalton 
h«.s,  in  the  several  editions  of  his  work  heretofore 
published,  labored  to  keep  step  with  the  ad  vancement 
la  science,  and  the  last  edition  shows  by  its  improve- 
ments on  former  ones  that  he  is  determined  to  main- 
tain the  high  standard  of  his  work.  We  predict  for 
the  present  edition  increased  favor,  though  this  work 
kas  long  been  the  favorite  standard. — Buffalo  Med. 
and  Surg.  Journal,  April,  1872. 

An  extended  notice  of  a  work  so  generally  and  fa- 
vorably known  as  this  is  unnecessary.  It  is  justly 
regarded  as  one  of  the  most  valuable  text-books  on 
the  subject  in  the  English  language. — St.  Louis  Med. 
Archives,  May,  1872. 

We  know  no  treatise  in  physiology  so  clear,  com- 
plete, well  assimilated,  and  perfectly  digested,  as 
Dalton's.  He  never  writes  cloudily  or  dubiously,  or 
in  mere  quotation.  He  assimilates  all  his  material, 
and  from  it  constructs  a  homogeneous  transparent 
argument,  which  is  always  honest  and  well  informed, 
and  hides  neither  truth,  ignorance,  nor  doubt,  so  far 
as  either  belongs  to  the  subject  in  hand — Brit.  Med. 
Journal,  March  23,  1872. 


Dr.  Dalton's  treatise  is  well  known,  and  by  many 
highly  esteemed  in  this  country.  It  is,  indeed,  a  good 
elementary  treatise  on  the  subject  it  professes  to 
teach,  and  may  safely  be  put  into  the  hands  of  Eng- 
lish students.  It  has  one  great  merit — it  is  clear,  and, 
on  the  whole,  admirably  illustrated.  The  part  we 
have  always  esteemed  most  highly  is  that  relating 
to  Embryology.  The  diagrams  given  of  the  various 
stages  of  development  give  a  clearer  view  of  the  sub- 
ject than  do  those  in  general  use  in  this  country ;  and 
the  text  may  be  said  to  be,  upon  the  whole,  equally 
clear. — London  Med.  Times  and  Gazette,  March  23, 
1872. 

Dalton's  Physiology  is  already,  and  deservedly, 
the  favorite  text-book  of  the  majority  of  American 
medical  students.  Treating  a  most  interesting  de- 
partment of  science  in  his  own  peculiarly  lively  and 
fascinating  style,  Dr.  Dalton  carries  his  reader  along 
without  effort,  and  at  the  same  time  impresses  upon 
his  mind  the  truths  taught  much  more  successfully 
than  if  they  were  buried  beneath  a  multitude  of 
words. — Kansas  Gity  Med.  Journal,  April,  1872. 

Professor  Dalton  is  regarded  justly  as .the  authority 
in  this  country  on  physiological  subjects,  and  the 
fifth  edition  of  his  valuable  work  fully  justifies  the 
exalted  opinion  the  medical  world  has  of  his  labors. 
This  last  edition  is  greatly  enlarged.—  Virginia  Clin- 
ical Record,  April,  1872. 


T)UNGLISON  (ROBLEY),  M.D., 

JLS  Professor  of  Institutes  of  Medicine  in  Jefferson  Medical  College,  Philadelphia. 

HUMAN  PHYSIOLOGY.     Eighth  edition.     Thoroughly  revised  and 

extensively  modified  and  enlarged,  with  five  hundred  and  thirty-two  illustrations.     In  two 
large  and  handsomely  printed  octavo  volumes  of  about  1500  pages,  cloth,  $7  00. 


TEHMANN(C.  O.}. 

PHYSIOLOGICAL  CHEMISTRY.  Translated  from  the  second  edi- 
tion by  GEORGE  E.  DAY,  M.  D.,  F.  R.  S.,  Ac.,  edited  by  R.  E.  ROGERS,  M.  D.,  Professor  of 
Chemistry  in  the  Medical  Department  of  the  University  of  Pennsylvania,  with  illustration* 
selected  from  Funke's  Atlas  of  Physiological  Chemistry,  and  an  Appendix  of  plates.  Com- 
plete in  two  large  and  handsome  octavo  volumes,  containing  1200  pages,  with  nearly  two 
hundred  illustrations,  cloth,  $6  00. 


•DY  THE  SAME  AUTHOR. 

MANUAL  OF  CHEMICAL  PHYSIOLOGY.    Translated  from  the 

German,  with  Notes  and  Additions,  by  J.  CHESTON  MORRIS,  M.  D.,  with  an  Introductory 
Essay  on  Vital  Force,  by  Professor  SAMUBL  JACKSON,  M.  D.,  of  the  University  of  Pennsyl- 
vania. With  illustrations  on  wood.  In  one  very  handsome  octavo  volume  of  336  pages, 
cloth,  $2  26. 


10 


HENRY  C.  LEA'S  PUBLICATIONS — (Chemistry). 


A  TTFIELD  (JOHN),  Ph.  D., 

"^^  Professor  of  Practical  Chemistry  to  the  Pharmaceutical  Society  of  Great  Britain,  *c. 

CHEMISTRY,   GENERAL,  MEDICAL,  AND  PHARMACEUTICAL; 

including  the  Chemistry  of  the  U.  S.  Pharmacopoeia.  A  Manual  of  the  General  Principle! 
of  the  Science,  and  their  Application  to  Medicine  and  Pharmacy.  Fifth  Edition,  revised 
by  the  author.  In  one  handsome  royal  12mo.  volume ;  cloth,  $2  75 ;  leather,  $3  25. 
(Lately  Issued.) 


No  other  American  publication  with  which  we  are 
acquainted  covers  the  same  ground,  or  does  it  so  well. 
In  addition  to  an  admirable  expose1  of  the  facts  and 
principles  of  general  elementary  chemistry,  the  au- 
thor has  presented  us  with  a  condensed  massof  prac- 
tical matter,  just  such  as  the  medical  student  and 
practitioner  needs.  —  Cincinnati  Lancet,  Mar.  1874. 

We  commend  the  work  heartily  as  one  of  the  best 
text-books  extant  for  the  medical  student.  —  Detroit 
Rev.  of  Med.  and  Pharm.,  Feb.  1872. 

The  best  work  of  the  kind  In  the  English  language. 
—  }?.  Y.  PsycholofficalJournal,  Jan.  1872. 


the  wants  of  medical  and  pharmaceutical  students; 
and,  although  an  English  work,  the  points  of  differ- 
ence between  the  British  and  United  States  Pharma- 
copoeias are  indicated,  making  it  as  useful  here  as  in 
England.  Altogether,  the  book  Is  one  we  can  heart- 
ily recommend  to  practitioners  as  well  as  students. 
—y.  7.  Med.  Journal,  Dec.  1871. 

It  differs  from  other  text-books  in  the  following 
particulars  :  first,  in  the  exclusion  of  matter  relating 
to  compounds  which,  at  present,  are  only  of  interest 
to  the  scientific  chemist  ;  secondly,  in  containing  the 
chemistry  of  every  substance  recognized  officially  or 
in  general,  as  a  remedial  agent.  It  will  be  found  a 
most  valuable  book  for  pupils,  assistants,  and  others 


engaged  in  medicine  and  pharmacy,  and  we  heartily 
commend  it  to  our  readers. — Canada  Lancet,  Oct. 
1871. 

When  the  original  English  edition  of  thiswork  was 
published,  we  had  occasion  to  express  our  high  ap- 
preciation of  its  worth,  and  also  to  review,  in  con- 
siderable detail,  the  main  features  of  the  book.  As 
the  arrangement  of  subjects,  and  the  main  part  of 
the  text  of  the  present  edition  are  similar  to  the  for- 
mer publication,  it  will  be  needless  for  us  to  go  over 
the  ground  a  second  time  ;  we  may,  however,  call  at- 
tention to  a  marked  ad  vantage  possessed  by  the  Ame- 
rican work — we  allude  to  the  introduction  of  tha 
chemistry  of  the  preparations  of  the  United  State* 
Pharmacopoeia,  as  well  aa  that  relating  to  the  British 
authority.  —  Canadian  Pharmaceutical  Journal, 
Nov.  1871. 

Chemistry  has  borne  the  name  of  being  a  hard  sub- 
ject to  master  by  the  student  of  medicine,  and 
chiefly  because  so  much  of  it  consists  of  compounds 
only  of  interest  to  the  scientific  chemist ;  in  this  work 
such  portions  are  modified  or  altogether  left  out,  and 
in  the  arrangement  of  the  subject- matter  of  the  work, 
practical  utility  is  sought  after,  and  we  think  fully 
attained.  We  commend  it  for  its  clearness  and  order 
to  both  teacher  and  pupil. — Oregon  Med.  and  Surg. 
Reporter,  Oct.  1871. 


-pOWNES  (GEORGE],  Ph.D. 
A  MANUAL  OF  ELEMENTARY  CHEMISTRY;   Theoretical  and 

Practical.  With  one  hundred  and  ninety-seven  illustrations.  A  new  American,  from  the 
tenth  and  revised  London  edition.  Edited  by  ROBERT  BRIDGES,  M.  D.  In  one  large 
royal  12mo.  volume,  of  about  850  pp.,  cloth,  $2  75  ;  leather,  $3  25.  (Lately  Issued.) 


This  work  is  so  well  known  that  it  seems  almost 
superfluous  for  us  to  speak  about  it.  It  has  been  a 
favorite  text-book  with  medical  students  for  years, 
and  Its  popularity  has  in  no  respect  diminished. 
Whenever  we  have  been  consulted  by  medical  stu- 
dents, as  has  frequently  occurred,  what  treatise  on 
chemistry  they  should  procure,  we  have  always  re- 
commended Fownes',  for  we  regarded  it  as  the  best. 
There  is  no  work  that  combines  so  many  excellen- 
ces. It  is  of  convenient  size,  not  prolix,  of  plain 
perspicuous  diction,  contains  all  the  most  recent 
discoveries,  and  is  of  moderate  price. — Cincinnati 
Med.  Repertory,  Aug.  1869. 

Large  additions  have  been  made,  especially  in  the 
department  of  organic  chemistry,  and  we  know  of  no 


other  work  that  has  greater  claims  on  the  physician, 
pharmaceutist,  or  student,  than  this.  We  cheerfully 
recommend  it  as  the  beat  text-book  on  elementary 
chemistry,  and  bespeak  for  it  the  careful  attention 
of  students  of  pharmacy. — Chicago  Pharmacist,  Ang. 
1869. 

Here  is  a  new  edition  which  has  been  long  watched 
for  by  eager  teachers  of  chemistry.  In  its  new  garb, 
and  under  the  editorship  of  Mr.  Watts,  it  has  resumed 
its-old  place  as  the  most  successful  of  text-books  — 
Indian  Medical  Gazette,  Jan.  1, 1869 

It  will  continue,  as  heretofore,  to  hold  the  first  ranli 
is  a  text-book  for  students  of  medicine. — Chicago 
Wed.  Examiner,  Ang.  1869. 


0 


DLING  ( WILLIAM), 

Lecturer  on  Chemistry  at  St.  Bartholomew's  Hospital,  Ac. 

A  COURSE  OF  PRACTICAL  CHEMISTRY,  arranged  for  the  Use 

of  Medical  Students.    With  Illustrations.    From  the  Fourth  and  Revised  London  Edition. 
In  one  neat  royal  12mo.  volume,  cloth,  $2. 


S1ALLOWAY  (ROBERT),  F.C.S., 

^-^  Prof,  of  Applied  Chemistry  in  the  Royal  College  of  Science  for  Ireland,  Ac. 

A  MANUAL  OF  QUALITATIVE  ANALYSIS.    From  the  Fifth  Lon- 

don  Edition.     In  one  neat  royal  12mo.  volume,  with  illustrations;  cloth,  $2  50.     (Just 
Issued.) 

The  success  which  has  carried  this  work  through  repeated  editions  in  England,  and  its  adoption 
as  a  text-book  in  several  of  the  leading  institutions  in  this  country,  show  that  the  author  has  suc- 
ceeded in  the  endeavor  to  produce  a  sound  practical  manual  and  book  of  reference  for  the  che- 
mical student. 

Prof.  Galloway's  books  are  deservedly  in  high  j  We  regard  this  volume  as  a  valuable  addition  to 
esteem,  and  this  American  reprint  of  the  fifth  edition  the  chemical  text-books,  and  as  particularly  calcu- 
(1869)  of  his  Manual  of  Qualitative  Analysis,  will  be  j  lated  to  instruct  the  student  in  analytical  researches 
acceptable  to  many  American  students  to  whom  the  :  of  the  inorganic  compounds,  the  important  vegetable 
English  edition  is  not  accessible. — Am.  Jour,  of  Sci-  acids,  and  of  compounds  and  various  secretions  avi 
tnce  and  Arts,  Sept.  1872.  excretions  of  animal  origin.—  Am.  Jovrn.  o 

I  Sept.  1672. 


HENRY  C.  LEA'S  PUBLICATIONS — (Chemistry). 


11 


T>LOXAM  (C.L.), 

•*-*  Profetnor  of  ChemMry  in  King's  College,  London. 

CHEMISTRY,  INORGANIC  AND  ORGANIC.     From  the  Second  Lon- 

don  Edition.     In  one  very  handsome  ootavo  volume,  of  700  pages,  with  about  300  illustra- 
tions.    Cloth,  $4  00  ;  leather,  $5  00.      (Lately  Issued.) 

It  has  been  the  author's  endeavor  to  produce  a  Treatise  on  Chemistry  sufficiently  oomprehen- 
give  for  those  studying  the  science  as  a  branch  of  ^  neral  education,  and  one  which  a  student 
•lay  use  with  advantage  in  pursuing  his  chemical  stud  s  atone  of  the  colleges  or  medical  schools. 
The  special  attention  devoted  to  Metallurgy  and  some  other  branches  of  Applied  Chemistry  renders 
the  work  especially  useful  to  those  who  are  being  educated  for  employment  in  manufacture. 
We  have  in  this  work  a  complete  and  most  excel-  experiment  have  been  worked  np  with  especial  care, 


lent  text-book  for  the  use  of  schools,  and  can  heart- 
ily recommend  it  as  such. — Boston  Med.  and  Surg. 
Journ.,  May  28,  1874. 

Of  all  the  numerous  works  upon  elementary  chem- 
istry that  have  been  published  within  the  last  few 
years,  we  can  point  to  none  that,  in  fulness,  accuracy, 
and  simplicity,  can  surpass  this;  while, in  the  num- 
ber and  detailed  descriptions  of  experiments,  as  also 
in  the  profuseness  of  its  illustrations,  we  believe  it 
stands  above  any  similar  work  published  in  this  coun- 


try. 


The  statements  made  are  clear  and  con- 


cise, and  every  step  proved  by  an  abundance  of  ex- 
periments, which  excite  our  admiration  as  much  by 
their  simplicity  an  by  their  direct  conclusiveness.  — 
Chicago  Med.  Examiner,  Nov.  15,  1873. 

It  is  seldom  that  in  the  same  compass  so  complete 
and  interesting  a  compendium  of  the  leading  facts  of 
ehemistry  is  offered.  —  Druggists'  Circular,  Nov.  '73. 

The  above  is  the  title  of  a  work  which  we  can  most 
conscientiously  recommend  to  students  of  chemistry. 
It  is  as  easy  as  a  work  on  chemistry  could  be  made, 
at  the  same  time  that  it  presents  a  full  account  of  that 
science  as  it  now  stands.  We  have  spoken  of  the 
workasadmirably  adapted  to  the  wants  of  students  ; 
it  is  quite  as  well  suited  to  the  requirements  of  prac- 
titioners who  wish  to  review  their  chemistry,  or  have 
occasion  to  refresh  their  memories  on  any  point  re- 
lating to  it.  In  a  word,  it  is  a  book  to  be  read  by  all 


sent  day.—  American  Practitioner,  Nov.  1873. 

Among  the  various  works  upon  general  chemistry 
issued,  we  know  of  none  that  will  supply  the  average 
wants  of  the  student  or  teacher  better  than  this.  — 
Indiana  Journ.  of  Med.,  Nov.  1873. 

We  cordially  welcome  this  American  reprint  of  a 
work  which  has  already  won  for  itself  so  substantial 
a  reputation  in  England.  Professor  Bloxam  has  con- 
densed into  a  ^onderfully  small  com  >ass  all  the  im- 
portant principles  and  facts  of  chemical  science. 
Thoroughly  imbued  with  an  enthusiastic  love  for  the 
science  he  expounds,  he  has  stripped  it  of  all  need- 
less technicalities,.and  rounded  out  its  hard  outlines 
by  a  fulness  of  illustration  that  cannot  fail  to  attract 
tnd  delight  the  student.  The  details  of  illustrative 


and  many  of  the  experiments  described  are  both  new 
and  striking.  —  Detroit  Rev.  of  Med.  and  Pharm., 
Nov.  1873. 

One  of  the  best  text-books  of  chemistry  yet  pub- 
lished. —  Chicago  Med.  Journ.,  Nov.  1873. 

This  is  an  excellent  work,  well  adapted  for  the  be- 
ginner and  the  advanced  student  of  chemistry.  —  Am. 
Journ.  of  Pharm.,  Nov.  1873. 

Probably  the  most  valuable,  and  at  the  same  time 
practical,  text-book  on  general  chemistry  extant  in 
our  language.  —  Kansas  Oity  Med.  Journ.,  Dec.  1873. 

Prof.  Bloxam  possesses  pre-eminently  the  inestima- 
ble gift  of  perspicuity.  It  ia  a  pleasure  to  read  his 
books,  for  he  in  capable  of  making  very  plain  what 
other  authors  frequently  have  left  very  obscure.  — 
Va.  Clinical  Record,  Nov.  1873. 

It  would  be  difficult  for  a  practical  chemist  and 
teacher  to  find  any  material  fault  with  this  most  ad- 
mirable treatise.  The  author  has  given  us  almost  a 
cyclopedia  within  the  limits  of  a  convenient  volume, 
and  has  done  so  without  penning  the  useless  para- 
raphs too  commonly  making  np  a  great  part  of  the 
lk  of  many  cumbrous  works.  The  progressive  sci- 
entist is  not  disappointed  when  he  looks  for  the  record 
of  new  and  valuable  processes  and  discoveries,  while 
the  cautious  conservative  does  not  find  its  pages  mo- 
nopolized by  uncertain  theories  and  speculations.  A 
peculiar  point  of  excellence  is  the  crystallized  form  of 
expression  in  which  great  truths  are  expressed  in 
very  short  paragraphs.  One  is  surprised  at  the  brief 
space  allotted  to  an  important  topic,  and  yet,  after 
reading  it,  he  feels  that  little,  if  any  more,  should 
have  been  said.  Altogether,  it  is  seldom  you  see  a 
text-book  so  nearly  faultless.—  Cincinnati  Lancet, 
Nov.  1873. 

Professor  Bloxam  has  given  us  a  most  excellent 
and  useful  practical  treatise.  His  666  pages  are 
crowded  with  facts  and  experiments,  nearly  all  well 
chosen,  and  .many  quite  new,  even  to  scientific  men. 
.  .  .  It  is  astonishing  how  much  information  he  often 
conveys  in  a  few  paragraphs.  We  might  quote  fifty 
instances  of  this.  —  Chemical  Kewa. 


gr 
bu 


1\7&HLER  ANV  FITTIG. 

OUTLINES  OF  ORGANIC  CHEMISTRY.    Translated  with  Ad- 

ditions from  the  Eighth  German  Edition.  By  IRA  REMSEN,  M.D.,  Ph.D.,  Professor  of 
Chemistry  and  Physics  in  Williams  College,  Mass.  In  one  handsome  volume,  royal  12mo. 
of  550  pp.,  cloth,  $3. 

As  the  numerous  editions  of  the  original  attest,  this  work  is  the  leading  text-book  and  standard 
Authority  throughout  Germany  on  its  important  and  intricate  subject  —  a  position  won  for  it  by 
the  clearness  and  conciseness  which  are  its  distinguishing  characteristics.  The  translation  has 
been  executed  with  the  approbation  of  Profs.  Wbhler  and  Fittig,  and  numerous  additions  and 
alterations  have  been  introduced,  so  as  to  render  it  in  every  respect  on  a  level  with  the  most 
advanced  condition  of  the  science.  _ 

0  WHAN  (JOHN  E.)  ,  M.  D. 

PRACTICAL  HANDBOOK  OF  MEDICAL  CHEMISTRY.    Edited 

by  C.  L.  BLOXAM,  Professor  of  Practical  Chemistry  in  King's  College,  London.      Sixth 
American,  from  the  fourth  and  revised  English  Edition.     In  one  neat  volume,  royal  12mo., 
pp.  351,  with  numerous  illustrations,  cloth,  $2  25. 
F  THE  SAME  AUTHOR.    (Lately  Issued.)       - 

INTRODUCTION   TO   PRACTICAL  CHEMISTRY,  INCLUDING 

ANALYSIS.  Sixth  American,  from  the  sixth  and  revised  London  edition.  With  numer- 
ous illustrations.  In  one  neat  vol.,  royal  12mo.,  cloth,  $2  25. 


& 


IHAPP'S  TECHNOLOGY  ;  or  Chemistry  Applied  to 
the  Arts,  and  to  Manufactures.  With  American 
itddiiioas,  by  Prof.  WALTER  B.  JoHiraov.  In  two 


very  handsome  octavo  volumes, 
engravings,  cloth,  $6  00. 


rith  600   wood 


12       HENRY  0.  LEA'S  PUBLICATIONS — (Mat.  Med.  and  Therapeutics). 


PARRISH  (ED  WARD), 

Late  Professor  of  Materiel  Medica  in  the  Philadelphia  College  of  Pharmacy. 

A  TREATISE  ON  PHARMACY.    Designed  as  a  Text-Book  for  the 

Student,  and  as  a  Guide  for  the  Physician  and  Pharmaceutist.  With  many  Formulae  and 
Prescriptions.  Fourth  Edition,  thoroughly  revised,  by  THOMAS  S.  WIEGAND.  In  one 
handsome  octavo  volume  of  977  pages,  with  280  illustrations;  cloth.  $5  50;  leather,  $6  50. 
(Just  Issued.) 

The  delay  in  the  appearance  of  the  new  TJ.  S.  Pharmacopoeia,  and  the  sudden  death  of  the  au- 
thor, have  postponed  the  preparation  of  this  new  edition  beyond  the  period  expected.  The  notes 
and  memoranda  left  by  Mr.  Parrish  have  been  plnced  in  the  hands  of  the  editor,  Mr.  Wiegand, 
who  has  labored  assiduously  to  embody  in  the  work  all  the  improvements  of  pharmaceutical  sci- 
ence which  have  been  introduced  during  the  last  ten  years.  It  is  therefore  hoped  that  the  new 
edition  will  fully  maintain  the  reputation  which  the  volume  has  heretofore  enjoyed  as  a  standard 
text-book  and  work  of  reference  for  all  engaged  in  the  preparation  and  dispensing  of  medicines. 

Of  Dr.  Parrish's  great  work  on  pharmacy  it  only  \  an  honored  place  on  our  own  bookshelves. — Dublin 
remains  to  be  said  that  the  editor  has  accomplished  Med.  Press  and  Circular,  Aug.  12,  1874. 
his  work  so  well  as  to  maintain  in  this  fourth  edi-  We  expressed  our  opinion  of  a  former  edition  in 
tion,  the  high  standard  of  excellence  which  it  bad  terms  of  nnqualified  praise  and  we  are  in  no  mood 
attained  in  previous  editions  under  the  editorship  of  |  to  detract  from  that  opinloQ  in  reference  to  the  pre- 
its  accomplished  author  This  has  not  been  acconv  j  gent  edition  the  preparation  of  which  has  fallen  into 
plished  without  much  labor,  and  many  additions  and  •  competent  hands.  It  is  a  book  with  which  no  pharma- 
improvements,  involving  changes  in  the  arrangement  d8t  can  di8pense  and  fron,  which  no  physician  can 
of  the  several  parts  of  the  work,  and  the  addition  of  faU  to  derive  much  inforlnaUon  of  valne  to  him  in 
much  new  matter.  With  the  modifications  thus  ef-  ,  practice.— Paci/c  Med.  andSurg.  Journ.,  June,  '74. 
fected  it  constitutes,  as  now  presented,  a  compendium  j  r 

of  the  science  and  art  indispensable  to  the  pharma-  With  these  few  remarks  we  heartily  commend  the 
cist,  and  of  the  utmost  value  to  every  practitioner  j  work,  and  have  no  doubt  that  it  will  maintain  its 
of  medicine  desirous  of  familiarizing  himself  with  i  old  reputation  as  a  text-book  for  the  student,  and  a 
the  pharmaceutical  preparation  of  the  articles  which  I  work  of  reference  for  the  more  experienced  physi- 


he  prescribes  for  his  patients. — Chicago  Med.Jou.rn., 
July,  1874. 

The  work  is  eminently  practical,  and  has  the  rare 
merit  of  being  readable  and  interesting,  while  it  pre- 
serves a  stricdy  scientific  character.  The  whole  work 
reflects  the  greatest  credit  on  author,  editor,  and  pub- 
lisher It  will  convey  some  idea  of  the  liberality  which 
has  been  bestowed  upon  its  production  when  we  men- 
tion thatthereare  no  less  than  2SOcarefully  executed 
illustrations.  In  conclusion,  we  heanily  recommend 
the  work,  not  only  to  pharmacists,  but  also  to  the 
multitude  of  medical  practitioners  who  are  obliged 
to  compound  their  own  medicines.  It  will  ever  hold 


cian   and   pharmacist. —  Chicago   Med.   Examiner, 
June  15,  1874. 

Perhaps  one,  if  not  the  most  important  book  upon 
pharmacy  which  has  appeared  in  the  English  lan- 
guage has  emanated  from  the  transatlantic  press. 
"Parrish's  Pharmacy"  is  a  well-known  work  on  this 
side  of  the  water,  and  the  fact  shows  us  that  a  really 
useful  work  never  becomes  merely  local  in  its  fame. 
Thanks  to  the  judicious  editing  of  Mr.  Wiegand,  the 
posthumous  edition  of  "Parrish"  has  been  saved  10 
the  public  with  all  the  mature  experience  of  its  au- 
thor, and  perhaps  none  the  worse  for  a  dash  of  new 
blood. — Land.  Pharm.  Journal,  Oct.  17,  1&74. 


GTILLE  (ALFRED),  M.D., 

Aj  Professor  of  Theory  and  Practice  of  Medicine  in  the  University  of  Penna. 

THERAPEUTICS  AND  MATERIA  MEDICA;  a  Systematic  Treatise 

on  the  Action  and  Uses  of  Medicinal  Agents,  including  their  Description  and  History. 

Fourth  edit.,  revised  and  enlarged.      In  two  large  and  handsome  8vo.  vols.  of  about  2008 

pages.     Cloth,  $10;  leather,  $12.      (Now  Ready.) 

The  care  bestowed  by  the  author  on  the  revision  of  this  edition  has  kept  the  work  ont  of  th8 
market  for  nearly  two  years,  and  has  increased  its  size  about  two  hundred  and  fifty  pages.  Not- 
withstanding this  enlargement,  the  price  has  been  kept  at  the  former  very  moderate  rate.  A  few 
notices  of  former  editions  are  subjoined. 

Or.  Stille's  splendid  work  on  therapeutics  and  ma- 1  abroad  its  reputation  asa  standard  treatise  on  Materia 
teria  medica. — London  Med.  Times,  April  8, 1865.  Medica  is  securely  established.  It  is  second  to  no 


Dr.  Stille  stands  to-day  one  of  the  best  and  most 
honored  representatives  at  home  and  abroad,  of  Ame- 
rican medicine ;  and  these  volumes,  a  library  in  them- 
selves, a  treasure-house  for  every  studious  physician, 
assure  his  fame  even  had  he  done  nothing  more. — The 
Western  Journal  of  Medicine,  Dec.  1868. 

We  regard  this  work  as  the  best  one  on  Materia 
Medica  in  the  English  language,  and  as  such  it  de- 
serves the  favor  it  has  received. — Am.  Journ.  Medi- 
cal Sciences,  July  1868 

We  need  not  dwell  on  the  merits  of  the  third  edition 
of  this  magnificently  conceived  work.  It  is  the  work 
on  Materia  Medica,  in  which  Therapeutics  are  prima- 
rily considered — the  mere  natural  history  of  drugs 


work  on  the  subject  in  the  English  tongue,  and,  ia- 
deed,  is  decidedly  superior,  in  some  respects,  to  any 
other.—  Pacific  Med.  and  Surg.  Journal,  July,  1S6S. 

Still6's  Therapeutics  is  incomparably  the  best  work 
on  the  subject.— .y.  Y.  Med.  Gazette,  Sept.  26,  1868. 

Dr.  Still6's  work  is  becoming  the  best  known  of  any 


of  our  treatises  on  Materia  Medica. 


One  of  th« 


most  valuable  works  in  the  language  on  the  subject* 
of  which  it  treats.— .tf.  T.  Med.  Journal,  Oct.  1868 

The  rapid  exhaustion  of  two  editions  of  Prof.  Still6'i 
scholarly  work,  and  the  consequent  necessity  for  a 
third  edition,  is  sufficient  evidence  of  the  high  esti- 
mate placed  upon  it  by  the  profession.  It  is  no  exag- 
geration to  say  that  there  is  no  superior  work  upoj 


being  briefly  disposed  of.     To  medical  practitioners  I  the  subject  in  the  English  language.     The  present 
this  is  a  very  valuable  conception.     It  is  wonderful  I  edition  is  fully  up  to  the  most  recent  advance  in  tb« 


how  much  of  the  riches  of  the  literature  of  Materia 
Medica  has  been  condensed  into  this  book.  The  refer- 
ences alone  would  make  it  worth  possessing.  But  it 
Is  not  a  mere  compilation.  The  writer  exercises  a 


science  and  art  of  therapeutics. — Leavemoorth  Medi- 
cal Herald,  Aug.  1868. 

The  work  of  Prof.  Still6  has  rapidly  taken  a  higb 
place  in  professional  esteem,  and  to  say  that  a  third 


good  Judgment  of  his  own  on  the  great  doctrines  and  j  edition  is  demanded  and  now  appears  before  ns,  suffl- 
points  of  Therapeutics.     For  purposes  of  practice,  j  ciently  attests  the  firm  position  this  treatise  has  mad« 


8till6's  book  is  almost  unique  as  a  repertory  of  in- 
formation, empirical  and  scientific,  on  the  actions  and 


for  itself.     As  a  work  of  great  research,  and  scholar- 
ship, it  is  safe  to  say  we  have  nothing  superior.     It  ii 


uses  of  medicines. — London  Lancet,  Oct.  31,  1868.        |  exceedingly  full,  and  the  busy  practitioner  will  flad 
Through  the  former  editions,  the  professional  world  j  ample  suggestions  upon  almost  every  important  poist 
Is  well  acquainted  with  this  work.     At  home  and  |  of  therapeutics.— Cincinnati  Lancet,  Aug.  1868. 


HENRY  C.  LEA'S  PUBLICATIONS— (Mat.  Med.  and  Therapeutics).       13 

QRIFFITH  (ROBERT  E.),  M.D. 

A  UNIVERSAL  FORMULARY,  Containing  the  Methods  of  Prepar- 
ing and  Administering  Officinal  and  other  Medicines.    The  whole  adapted  to  Physician-  and 
Pharmaceutists.     Third  edition,  thoroughly  revised,  with  numerous  additions,  bj  JOHN  M. 
MAISCH,  Professor  of  Materia  Medica  in  the  Philadelphia  College  of  Pharmacy.   In  one  large 
andhandsome  octavo  volume  of  aboutSOfl  pages,  cloth,  $4  50  ;  leather,  $5  50.    (Just  Issued  ) 
This  work  has  long  been  known  for  the  vast  amount  of  information  which  it  present?  in  a  con- 
densed form,  arranged  for  easy  reference.     The  new  edition  has  received  the  most  careful  revi- 
sion  at  the  competent  hands  of  Professor  Maiscb,  who  has  brought  the  whole  up  to  the  standard  of 
the  most  recent  authorities.     More  than  eighty  new  headings  of  remedies  have  been  introduced, 
the  entire  work  has  been  thoroughly  remodelled,  and  whatever  has  seemed  to  be  obsolete  has  been 
omitted.     As  a  comparative  view  of  the  United  States,  the  British,  the  German,  and  the  French 
Pharmacopoeias,  together  with  an  immense  amount  of  unofficial  formulas,  it  affords  to  the  prac- 
titioner and  pharmaceutist  an  aid  in  their  daily  avocations  not  to  be  found  elsewhere,  while  three 
indexes,  one  of  "Diseases  and  their  Remedies,"  one  of  Pharmaceutical  Names,  and  a  General 
Index,  afford  an  easy  key  to  the  alphabetical  arrangement  adopted  in  the  text. 


The  young  practitioner  will  find  the  work  invalu- 
able in  suggesting  eligible  modes  of  administering 
many  remedies. — Am.  Journ.  of  Pharm.,  Feb.  1874. 

Our  copy  of  Griffith's  Formulary,  after  long  use, 
first  in  the  dispensing  shop,  and  afterwards  in  our 
medical  practice,  had  gradually  fallen  behind  in  the 
onward  march  of  materia  medica,  pharmacy,  and 
therapeutics,  until  we  had  ceased  to  consult  it  as  a 
daily  book  of  reference.  So  completely  has  Prof. 
Maisch  reformed,  remodelled,  and  rejuvenated  it  in 
the  new  edition,  we  shall  gladly  welcome  it  back  to 
ourtable  again  beside  Dunglison,  Webster,  and  Wood 
&  Bache.  The  publisher  could  not  have  been  more 
fortunate  in  the  selection  of  an  editor.  Prof.  Maisch 
is  emineutly  the,  man  for  the  work,  and  he  has  done 
it  thoroughly  and  ably*  To  enumerate  the  altera- 
tions, amendments,  and  additions  would  be  an  end- 
less task  ;  everywhere  we  are  greeted  with  the  evi- 
dences of  his  labor.  Following  the  Formulary,  is  an 
addendum  of  useful  Recipes,  Dietetic  Preparations, 
List  of  Incompatibles,  Posological  table,  table  of 
Pharmaceutical  Names,  Officinal  Preparations  and 
Directions,  Poisons.  Anlidotes  and  Treatment,  and 


To  the  druggist  a  good  formulary  is  simply  indis- 
pensable, and  perhaps  no  formulary  has  been  more 
extensively  used  than  the  well-known  work  before 
us.  Many  physicians  have  to  officiate,  also,  as  drug- 
gists. This  is  true  especially  of  the  country  physi- 
cian, and  a  work  which  shall  teach  him  the  means 
by  which  to  administer  or  combine  his  remedies  in 
the  most  efficacious  and  pleasant  manner,  will  al- 
ways hold  its  place  upon  his  shelf.  A  formulary  of 
this  kind  is  of  benefit  also  to  the  city  physician  in 
largest  practice.— Cincinnati  dlinic,  Feb.  21,  1874. 

The  Formulary  has  already  proved  itself  accepta- 
ble to  the  medical  profession,  and  we  do  not  hesitate 
to  say  that  the  third  edition  is  much  improved,  and 
of  greater  practical  value,  in  consequence  of  the  care- 
ful revision  of  Prof.  Maisch.— Chicago  Med.  Exam- 
iner, March  15,  1874. 

A  more  complete  formulary  than  it  is  in  its  pres- 
ent form  the  pharmacist  or  physician  could  hardly 
desire.  To  the  first  some  such  work  is  indispensa- 
ble, and  it  is  hardly  less  essential  to  the  practitioner 
who  compounds  his  own  raediciaes.  Much  of  what 
is  contained  in  the  introduction  ought  to  be  com- 


.  .  LW*VO»WI1»)    O.UU          13     UVJI1  CttlUtm     IU     LUO     LHIrTlfUUUUVU     UUgUL     LU      UB      '    'U!l 

copious  indices,  which  afford  ready  access  to  all  parts  milled  lo  memory  by  every  student  of  medicine, 
of  the  work.  We  unhesilatingly  commend  the  book  \  As  a  help  to  physicians  it  will  be  found  invaluable, 
as  bemg  -he  best  of  its  kind,  within  our  knowledge  and  doubtless  will  make  its  way  into  libraries  not 
—Atlanta  Med.  and  Surg.  Journ.,  Feb.  1874.  already  supplied  with  a  standard  work  of  the  kind. 

I  — The  American  Practitioner,  Louisville,  July,  '74. 


E 


'LLIS  [BENJAMIN],  M.D. 

THE  MEDICAL  FORMULARY:  being  a  Collection  of  Prescriptions 

derived  from  the  writings  and  practice  of  many  of  the  most  eminent  physicians  of  America 
and  Europe.  Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.  The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.  Twelfth  edi- 
tion, carefully  revised  and  much  improved  by  ALBERT  H.  SMITH,  M.  D.  In  one  volumeSva. 
of  376  pages,  cloth,  $3  00. 


IEREIRA  (JONATHAN],  M.D.,  F.R.S.  and  L.S. 
MATERIA   MEDICA  AND  THERAPEUTICS;   being  an  Abridg- 

ment  of  the  late  Dr.  Pereira's  Elements  of  Materia  Medica,  arranged,  in  conformity  with 
the  British  Pharmacopoeia,  and  adapted  to  the  use  of  Medical  Practitioners,  Chemists  ar.d 
Druggists,  Medical  and  Pharmaceutical  Students,  Ac.  By  F.  J.  FARRE,  M.D. ,  Senior 
Physician  to  St.  Bartholomew's  Hospital,  and  London  Editor  of  the  British  Pharmacopoeia ; 
assisted  by  ROBEKT  BENTLEY,  M.R.C.S.,  Professor  of  Materia  Medica  and  Botany  to  the 
Pharmaceutical  Society  of  Great  Britain;  and  by  ROBERT  WARINGTON,  F.R.S.,  Chemical 
Operator  to  the  Society  of  Apothecaries.  With  numerous  additions  and  references  to  the 
United  States  Pharmacopeia,  by  HORATIO  C.  WOOD,  M.D.,  Professor  of  Botany  in  the 
University  of  Pennsylvania.  In  one  large  andhandsome  octavo  volume  of  1040  closely 
printed  pages,  with  236  illustrations,  cloth,  $7  00;  leather,  raised  bands,  $8  00. 


DUNGLISON'S  NEW  REMEDIES.  WITH  FORMULA 
FOR  THEIR  PREPARATION  AND  ADMINISTRA- 
TION. Seventh  edition,  with  extensive  additions. 
One  vol.  8vo.,  pp.  770;  cloth.  $4  00. 

BOYLE'S  MATERIA  MEDICA  AND  THERAPEU- 
TICS.  Edited  by  JOSEPH  CARSON,  M.  D.  With 
ninety-eight  illustrations.  1  vol.  8vo.,  pp.  700, 
cloth.  $3  00. 

CARSON'S  SYNOPSIS  OF  THE  LECTURES  ON  MA- 
TERIA MEDICA  AND  PHARMACY,  delivered  in 
the  University  of  Pennsylvania.  Fourth  and  re- 
vised edition.  Cloth,  $.3. 


'•HRISTISON'S  DISPENSATORY.  With  copious  ad 
'itlong.  «.nd  213  large  wood-nneravingg  Bv  R. 
EOLESFELD  GRIFFITH,  M.D.  One  vol.  8vo.,pp.  1000; 
cloth.  $4  00. 

CARPENTER'S  PRIZE  ESSAY  ON  THE  USE  OF 
ALCOHOLIC  LIQUORS  IN  HEALTH  AND  DISRASE.  New 
edition,  with  a  Preface  by  D.  F.  CONDIE,  M.D.,  and 
explanations  of  scientific  words.  In  one  neat  12mo. 
volume,  pp.  178,  cloth.  60  cents. 

DE  JONGH  ON  THE  THREE  KINDS  OF  COD-LITER 
OIL,  with  their  Chemical  and  Therapeutic  Pro- 
perties. 1  vol.  12mo.,  cloth.  75  cents. 


14 


HENRY  C.  LEA'S  PUBLICATIONS — (Pathology,  <§<?.)• 


WEN  WICK  (SAMUEL),  M.D., 

-*•  Assistant  Physician  to  the  London  Hospital. 

THE  STUDENT'S  GUIDE  TO  MEDICAL  DIAGNOSIS.     From  the 

Third  Revised  and  Enlarged  English  Editior.     With  eighty-four  illustrations  on  wood. 
In  one  very  handsome  volume,  royal  12mo.,  cloth,  $2  25.     (Just  Issued.) 
The  very  great  success  which  this  work  has  obtained  in  England,  shows  that  it  has  supplied  an 
admitted  want  among   elementary  books  for  the  guidance  of  students  and  junior  practitioners. 
Taking  up  in  order  each  portion  of  the  body  or  class  of  disease,  the  author  has  endeavored  to 
present  in  simple  language  the  value  of  symptoms,  so  as  to  lead  the  student  lo  a  correct  appreci- 
ation of  the  pathological  changes  indicated  by  them.     The  latest  investigations  have  been  care- 
fully introduced  into  the  present  edition,  so  that  it  may  fairly  be  considered  as  on  a  level  with 
the  most  advanced  condition  of  medical  science. 


Of  the  many  guide-books  on  medical  diagnosis, 
claimed  to  be  written  for  the  special  instruction  of 
students,  this  is  the  best.  The  author  is  evidently  a 
well-read  and  accomplished  physician, and  he  knows 
how  to  'each  practical  medicine.  The  charm  of  sim- 
plicity is  not  the  least  interesting  feature  in  the  man- 
ner in  which  Dr.  Fen» ick  conveys  instruction.  There 
are  few  books  of  this  size  on  practical  medicine  that 
contain  so  much  and  convey  it  so  well  as  the  volume 
before  us.  It.  is  a  book  we  can  sincerely  recommend 
to  the  student  for  direct  instruction,  and  to  the  prac- 
titioner as  a  ready  and  useful  aid  to  his  memory. — 
Am.  Journ.  of  Syphilography,  Jan.  1874. 

It  covers  the  ground  of  medical  diagnosis  in  a  con- 


cise, practical  manner,  well  calculated  to  assist  the 
student  in  forming  a  correct,  thorough,  and  system- 
atic method  of  examination  and  diagnosis  of  disease. 
The  illustrations  are  numerous,  and  finely  executed. 
Those  illustrative  of  the  microscopic  appearance  of 
morbid  tissue,  &c.,  are  especially  clear  and  distinct. 
— Chicago  Med.  Examiner,  Nov.  1£73. 

So  far  superior  to  any  offered  to  students  that  the 
colleges  of  this  country  should  recommend  it  to  their 
respective  classes. — jV.  0.  Med.  and  Surg.  Journ., 
March,  1874. 

This  little  hook  ought  to  be  in  the  possession  of 
every  medical  student. — Boston  Medical  and  Surg. 
Journ.,  Jan.  15,  1874. 


riREEN  (T.  HENRY],  M.D., 

^-"  Lecturer  on  Pathology  and  Morbid  Anatomy  at  Charing-Cross  Hospital  Medical  School. 

PATHOLOGY  AND  MORBID  ANATOMY.     With  numerous  Illus- 

trations  on  Wood.     In  one  very  handsome  octavo  volume  of  over  240  pages,  cloth,  $2  50. 
(Lately  Published.) 

We  have  been  very  much  pleased  by  our  perusal  of  thology  and  morbid  anatomy.  The  author  shows  that 
this  little  volume.  It  is  the  only  one  of  the  kind  with  he  has  been  not  only  a  student  of  the  teachings  of  his 
which  we  are  acquainted,  and  practitioners  as  well  confreres  in  this  branch  of  science,  but  a  practical 
as  students  will  find  it  a  very  useful  guide  ;  for  the  and  conscientious  laborer  in  the  post-mortem  chain- 


information  is  up  to  the  day,  well  and  compactly  ar- 
ranged, without  being  at  all  scanty. — London  Lan- 
cet, Oct.  7,  1871. 

It  embodies  in  a  comparatively  small  space  a  clear 
statement  of  the  present  state  of  our  knowledge  of  pa- 


ber.  The  work  will  provea  useful  one  to  the  great 
mass  of  students  and  practitioners  whose  time  for  de- 
votion to  this  class  of  studies  is  limited. — Am.  Journ. 
of  Syphilography,  April,  1872. 


QLUGE'S  ATLAS  OF  PATHOLOGICAL  HISTOLOGY. 
Translated,  with  Notes  and  Additions,  by  JOSEPH 
LEIDT,  M.  D.  In  one  volume,  very  large  imperial 
quarto,  with  320  copper-plate  figures,  plain  and 
colored,,  cloth.  $4  00. 

JONES  AND  SIEVEKING'S  PATHOLOGICAL  ANA- 
TOMY. With  397  wood-cuts.  1  vol.  Svo.,  of  nearly 
7.00  pages,  cloth.  $3  50. 

HOLLAND'S  MEDICAL  NOTES  AND  REFLEC- 
TIONS. 1  vol.  8vo.,  pp.  500,  cloth.  $3  50 

WH  ATTO  OBSERVE  AT  THE  BEDSIDE  AND  AFTEJi 
DEATH  IK  MEDICAL  CASES.  Published  under  tht 
authority  of  the  London  Society  for  Medical  Obsqr- 
vation.  From  the  second  London  edition.  1  vol. 
royal  12mo.,  cloth.  $1  00. 


LA  ROCHE  ON  YELLOW  FEVER,  considered  in  its 
Historical,  Pathological,  Etiological,  and  Therapeu- 
tical Relations.  In  two  large  and  handsome  octavo 
volumes  of  nearly  1500  pages,  cloth.  $7  00. 

LAYCOCK'S  LECTURES  ON  THE  PRINCIPLES 
AND  METHODS  OF  MEDICAL  OBSERVATION  AND  RE- 
SEARCH. For  the  use  of  advanced  students  and 
junior  practitioners.  In  one  very  neat  royal  12mo. 
volume,  cloth.  $1  00. 

BARLOW'S  MANUAL  OF  THE  PRACTICE  OF 
MEDICINE.  With  Additions  by  D.  F.  CONDIB, 
M.  D.  1  vol.  fivo.,  pp.  600.  cloth.  f2  50. 

TODD'S  CLINICAL  LECTURES  ON  CERTAIN  ACUTB 
DISEASES.  In  one  neat  octavo  volume,  of  320  pages, 
cloth.  $2  50. 


VTURGES  (DCTAVIUS),  M.D.  Cantab., 

**J  Fellow  of  the  Royal  College  of  Physicians,  <tc.  <tc. 

AN  INTRODUCTION  TO  THE  STUDY  OF  CLINICAL  MED- 
ICINE. Being  a  Guide  to  the  Investigation  of  Disease,  for  the  Use  of  Students.  In  one 
handsome  12mo.  volume,  cloth,  $1  25.  (Just  Issued.) 


D 


AVIS  (NATHAN  S.), 

Prof,  of  Principles  and  Prarticc  of  Medicine,  etc.,  in  Chicago  Me.d.  College. 

CLINICAL  LECTURES  ON  VARIOUS   IMPORTANT   DISEASES ; 

being  a  collection  of  the  Clinical  Lectures  delivered  in  the  Medical  Wards  of  Mercy  Hos- 
pital, Chicago.  Edited  by  FRANK  H.  DAVIS,  M.D.  Second  edition,  enlarged.  In  one 
handsome  royal  12mo.  volume.  Cloth,  $1  75.  (Now  Ready.) 


VTOKES  (WILLIAM),  M.D..  D.C.L.,  F.R.S., 

~-^  Reyiua  Prnfesifir  of  Physic  in  the  Univ.  of  Dublin,  Ac. 

LECTURES  ON  FEVER,  delivered  in  the  Theatre  of  the  Meath  Hos- 

•"•^      pital  and  County  of  Dublin  Infirmary.     Edited  by  JOHN  WILLIAM  MOORE,  M.D  ,  Assistant 
Physician  to  the  Cork  Street  Fever  Hospital.     In  one  neat  octavo  volume.      (Preparing.) 
#*%  To  appear  in  the  "  MEDICAL  NEWS  AND  LIBRARY"  for  1875. 


HENRY  C.  LEA'S  PUBLICATIONS — (Practice  of  Medicine). 


15 


FLINT  (AUSTIN),  M.D., 

•*•  Professor  of  the  Principles  and  Practice  of  Medicine  in  Bellevue  Med.  College  N  Y 

A  TREATISE    ON    THE    PRINCIPLES    AND    PRACTICE    OF 

MEDICINE  ;  designed  for  the  use  of  Students  and  Practitioners  of  Medicine.     Fourth 
edition,  revised  and  enlarged.   In  one  large  and  closely  printed  octavo  volume  of  about  1100 
pages ;  cloth,  $6  00  ;  or  strongly  bound  in  leather,  with  raised  bands,  $7  00.    (.Just  Issued.) 
By  common  consent  of  the  English  and  American  medical  press,  this  work  has  been  assigned 
to  the  highest  position  as  a  complete  and  compendious  text-book  on  the  most  advanced  condition 
of  medical  science.     At  the  very  moderate  price  at  which  it  is  offered  it  will  be  found  one  of  the 
Cheapest  volumes  now  before  the  profession.     A  few  notices  of  previous  editions  are  subjoined. 


Admirable  and  unequalled.  —  Western  Journal  of 
Jfedivine,  Nov.  1869. 

Dr.  Flint's  work,  though  claiming  no  higher  title 
than  that  of  a  text-book,  is  really  more.  He  is  a  man 
of  large  clinical  experience,  and  his  book  is  full  of 
•uch  masterly  descriptions  of  disease  as  can  only  be 
drawn  by  a  man  intimately  acquainted  with  their 
various  forms.  It  is  not  so  long  since  we  had  the 
pleasure  of  reviewing  his  first  edition,  and  we  recog- 
nize a  great  improvement,  especially  in  the  general 
part  of  the  work.  It  is  a  work  which  we  can  cordially 
recommend  to  our  readers  as  fully  abreast  of  the  sci- 
ence of  the  day.—  Edinburgh  Me.d.  Journal,  Oct.  '69. 

One  of  the  best  works  of  the  kind  for  the  practi- 
tioner, and  the  most  convenient  of  all  for  the  student. 
—Am.  Journ.  Med.  Sciences,  Jan.  1869. 

This  work,  which  stands  pre-eminently  as  the  ad- 
rance  standard  of  medical  science  up  to  the  present 
time  in  the  practice  of  medicine,  has  for  its  author 
one  who  is  well  and  widely  known  as  one  of  the 
leading  practitioners  of  this  continent.  In  fact,  it  is 
seldom  that  any  work  is  ever  issued  from  the  press 
more  deserving  of  universal  recommendation. — Do- 
minion Med.  Journal,  May,  1869. 

The  third  edition  of  this  most  excellent  book  scarce- 
ly needs  any  commendation  from  us.  The  volume, 
as  it  stands  now,  Is  really  a  marvel :  first  of  all,  it  is 


sxcelleutly  printed  and  bound — and  we  encounter 
that  luxury  of  America,  the  ready-cut  pages,  which 
the  Yankees  are  'cute  enough  to  insist  upon — nor  are 
these  by  any  means  trifles  ;  but  the  contents  of  the 
book  are  astonishing.  Not  only  is  it  wonderful  that 
any  one  man  can  have  grasped  in  his  mind  the  whole 
scope  of  medicine  with  that  vigor  which  Dr.  Flint 
shows,  but  the  condensed  yet  clear  way  in  which 
this  is  done  is  a  perfect  literary  triumph.  Dr.  Flint 
Is  pre-eminently  one  of  the  strong  men,  whose  right 
to  do  this  kind  of  thing  is  well  admitted  ;  and  we  say 
no  more  than  the  truth  when  we  affirm  that  he  is 
rery  nearly  the  only  living  man  that  could  do  it  with 
mch  results  as  the  volume  before  us. — The  London 
Practitioner,  March,  1869. 

This  is  in  some  respects  the  best  text-book  of  medi- 
cine in  our  language,  and  it  is  highly  appreciated  on 
the  other  side  of  the  Atlantic,  inasmuch  as  the  first 
edition  was  exhausted  in  a  few  months.  The  second 
edition  was  little  more  than  a  reprint,  but  the  present 
has,  as  the  author  says,  been  thoroughly  revised. 
Much  valuable  matter  has  been  added,  and  by  mak- 
ing the  type  smaller,  the  bulk  of  the  volume  is  not 
much  increased.  The  weak  point  in  many  American 
works  is  pathology,  but  Dr.  Flint  has  taken  peculiar 
pains  on  this  point,  greatly  to  the  value  of  the  book. 
— London  Med.  Times  and  Gazette,  Feb.  6, 1869. 


or  THE  SAME  AUTHOR: 

ESSAYS    ON    CONSERVATIVE   MEDICINE    AND    KINDRED 

TOPICS.     In  one  very  handsome  royal  12mo.  volume.     Cloth,  $1  38.     (Just  Issued.) 

CONTENTS. 

I.  Conservative  Medicine.  II.  Conservative  Medicine  as  applied  to  Therapeutics.  III.  Cin- 
servative  Medicine,  as  applied  to  Hygiene.  IV.  Medicine  in  the  Past,  the  Present,  and  the  Fu- 
ture. V.  Alimentation  in  D  sense.  VI.  Tolerance  of  Disease.  VII.  On  the  Agency  of  the 
Mind  in  Etiology,  Prophylaxis,  and  Therapeutics.  VIII.  Divine  design  as  exemplified  in  the 
Natural  History  of  Disease. 


TSON  (THOMAS),  M.  D.,  £c. 
LECTURES    ON    THE     PRINCIPLES 


AND    PRACTICE    OF 


PHYSIC.  Delivered  at  King's  College,  London.  A  new  American,  from  the  Fifth  re- 
vised and  enlarged  English  edition.  Edited,  with  additions,  and  several  hundred  illustra- 
ntions,  by  HENRY  HARTSHORNE,  M.D.,  Professor  of  Hygiene  in  the  University  of  Pennsylv. 
nia.  In  two  large  and  handsome  Svo.vols.  Cloth,  $9  00;  leather,  $11  00.  (Lately  PublisJied  .) 


It  is  a  subject  for  congratulation  and  for  thankful- 
ness that  Sir  Thomas  Watson,  during  a  period  of  com- 
parative leisure,  after  a  long,  laborious,  and  most 
honorable  professional  career,  while  retaining  full 
possession  of  his  high  mental  faculties,  should  have 
employed  the  opportunity  to  submit  his  Lectures  to 
a  more  thorough  revision  than  was  possible  during 
the  earlier  and  busier  period  of  his  life.  Carefully 
passing  in  review  some  of  the  most  intricate  and  im- 
portant pathological  and  practical  questions,  there- 
suits  of  his  clear  insight  and  his  calm  judgment  are 
now  recorded  for  the  benefit  of  mankind,  in  language 
which,  for  precision,  vigor,  and  classical  elegance,  has 
rarely  been  equalled,  and  never  surpassed  The  re- 
vision has  evidently  been  most  carefully  done,  and 
the  results  appear  in  almost  every  page. — Brit.  Med. 
Journ.,  Oct.  14,  1871. 

The  lectures  are  so  well  known  and  so  justly 
appreciated,  that  it  is  scarcely  necessary  to  do 
more  than  call  attention  to  the  special  advantages 
of  the  last  over  previous  editions.  The  author's 


rare  combination  of  great  scientific  attainments  com- 
bined with  wonderful  forensic  eloquence  has  exerted 
extraordinary  influence  over  the  last  two  generations 
of  physicians.  His  clinical  descriptions  of  most  dis- 
eases have  never  been  equalled  ;  and  on  this  score 
at  least  his  work  will  live  long  in  the  future.  The 
work  wil'.  be  sought  by  all  who  appreciate  a  great 
book. — Amer.  Journ.  of  Syphilography,  July,  1872. 
We  are  exceedingly  gratified  at  the  reception  of 
this  new  edition  of  Watson,  pre-eminently  the  prince 
of  English  authors,  on  "Practice."  We,  who  read 
the  first  edition  shall  never  forget  the  great  pleasure 
and  profit  we  derived  from  its  graphic  delineations 
of  disease,  its  vigorous  style  and  splendid  English. 
Maturity  of  years,  extensive  observation,  profound 
research,  and  yet  continuous  enthusiasm,  have  com- 
bined to  give  us  in  this  latest  edition  a  model  of  pro- 
fessional excellence  in  teaching  with  rare  beauty  in 
the  mode  of  communication.  Bnt  this  classic  needs 
no  eulogium  of  ours. — Chicago  Med.  Journ.,  July, 
1872. 


D 


UNGLISON,  FORBES,  TWEEDIE,  AND  CONOLLY. 

THE  CYCLOPAEDIA  OF   PRACTICAL  MEDICINE:   comprising 

Treatises  on  the  Nature  and  Treatment  of  Diseases,  Materia  Medica  and  Therapeutics, 
Diseases  of  Women  and  Children,  Medical  Jurisprudence,  <tc.  Ac.  In  four  large  super-royai 
octavo  volumes,  of  3254  double-columned  pages,  strongly  and  handsomely  bound  in  leather, 
$15;  cloth,  $11. 


16  HENRY  C.  LEA'S  PUBLICATIONS — (Practice  of  Medicine). 

LTA  R  TSHORNE  ( HENR  F) ,  M.  D., 

*••*•  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

ESSENTIALS  OF  THE  PRINCIPLES  AND  PRACTICE  OF  MEDI- 

CINE.  A  handy-book  for  Students  and  Practitioners.  Fourth  edition,  revised  and  im- 
proved. With  about  one  hundred  illustrations.  In  one  handsome  royal  12mo  volume, 
of  about  550  pages,  cloth,  $2  63  ;  half  bound,  $2  88.  (Just  Ready.) 

The  thorough  manner  in  which  the  author  has  labored  to  fully  represent  in  this  favorite  hand- 
book the  most  advanced  condition  of  practical  medicine  is  shown  by  the  fact  that  the  present 
edition  contains  more  than  250  additions,  representing  the  investigations  of  172  authors  not  re- 
ferred to  in  previous  editions.  Notwithstanding  an  enlargement  of  the  page,  the  size  has  been 
increased  by  sixty  pages.  A  number  of  illustrations  have  been  introduced  which  it  is  hoped 
will  facilitate  the  comprehension  of  details  by  the  reader,  and  no  effort  has  been  spared  to  make 
the  volume  worthy  a  continuance  of  the  very  great  favor  with  which  it  has  hitherto  been  received. 

The  work  is  brought  fully  up  with  all  the  recent  ;  many  particulars,  and  is  fully  up  to  the  most  ad- 
Hdvances  in  medicine,  is  admirably  condensed,  and  vanced  state  of  the  science. — Leavenworth  Medieal 
yet  sufficiently  explicit  for  all  the  purposesintended,  Herald,  Nov.  1874. 

t'hus  making  it  by  far  the  best  work  of  its  character        Without  doubt  the  best  book  of  the  kind  published 
ever  published.— Cincinnati  CHnic,  Oct.  24,  1874.         in  the  Engijgh  language.— St.  Louis  Med.  and  Surg. 

We  have  already  had  occasion  to  notice  the  previ-  j  Journ->  Nov-  1874. 

ous  editions  of  this  work.     It  is  excellent  of  its  kind,  i      Asa  handbook,  which  clearly  sets  forth  the  ESSEN- 
The  author  has  given  a  very  careful  revision,  in  view  |  TIAI,S  of  the  PRINCIPLES  AND  PRACTICE  OF  MEDICINE,  we 


of  the  rapid  progress  of  medical  science. — N.  Y.  Med. 
Journ.,  Nov.  1874. 

The  present  edition  of  Dr.  Hartshorne's  work  is  a 


do  not  know  of  its  equal.—  Va.  Med.  Monthly. 

As  a  brief,  condensed,  but  comprehensive  hand- 
book, it  cannot  be  in- proved  upon. — Chicago  Med. 


very  decided  improvement  upon  the  former  ones  in  I  Examiner,  Nov.  15,  1874. 

f>AVY(F.W.),M.D.,F.R.S., 

tT  Senior  Asst.  Physician  to  and  Lecturer  on  Physiology,  at  Guy's  Hospital,  &c. 

A  TREATISE  ON  THE   FUNCTION  OF  DIGESTION ;  its  Disor- 

ders  and  their  Treatment.     From  the  second  London  edition.     In  one  handsome  volume, 

small  octavo,  cloth,  $2  00.  

J)Y  THE  SAME  AUTHOR.    (Just  Ready. 

A  TREATISE  ON  FOOD  AND  DIETETICS,  PHYSIOLOGI- 
CALLY AND  THBKAPEUTICALLY  CONSIDERED.  In  one  handsome  octavo  volume 
of  nearly  600  pages,  cloth,  $4  75. 

SUMMARY  OP  CONTENTS. 

Introductory  Remarks  on  the  Dynamic  Relations  of  Food — On  the  Origination  of  Food — The 
Constituent  Relations  of  Food — Alimentary  Principles,  their  Classification,  Chemical  Relations, 
Digestion,  Assimilation,  and  Physiological  Uses — Nitrogenous  Alimentary  Principles — Non-Ni- 
trogenous Alimentary  Principles — The  Carbo-Hydrates — The  Inorganic  Alimentary  Principles — 
Alimentary  Substances — Animal  Alimentary  Substances — Vegetable  Alimentary  Substances — 
Beverages — Condiments — The  Preservation  of  Food — Principles  of  Dietetics — Practical  Dietetics 
— Diet  of  Infants — Diet  for  Training — Therapeutic  Dietetics — Dietetic  Preparations  for  the  Inva- 
lid— Hospital  Dietaries. 

{CHAMBERS  ( T.  K.),  M.  D.     (Lately  Published.} 

O  Consulting  Physician  to  St.  Mary's  Hospital,  London,  Ac. 

THE  INDIGESTIONS ;  or,  Diseases  of  the  Digestive  Organs  Functionally 

Treated.   Third  andrevised  Edition.   In  one  handsome  8vo.  vol.  of  333  pages,  cloth,  $3  00. 
TOY  THE  SAME  AUTHOR.    (Lately  Published.) 

RESTORATIVE  MEDICINE.     An  Harveian  Annual  Oration.     With 

Two  Sequels.     In  one  very  handsome  volume,  small  12mo.,  cloth,  $1  00. 
J)Y  THE  SAME  AUTHOR.     (Now  Ready.) 

A  MANUAL  OF  DIET  AND  REGIMEN  IN  HEALTH  AND  SICK- 

NESS.     In  one  handsome  octavo  volume.     Cloth,  $2  75. 

The  aims  of  this  handbook  are  purely  practical,  and  therefore  it  has  not  been  thought  right 
to" increase  its  size  by  the  addition  of  the  chemical,  botanical,  and  industrial  learning  which 
rapidly  collects  round  the  nucleus  of  every  article  interesting  as  an  eatable.  Space  has  been 
thus  gained  for  a  full  discussion  of  many  matters  connecting  food  and  drink  with  the  daily  cur- 
rent of  social  life,  which  the  position  of  the  author  as  a  practising  physician  has  led  him  to 
believe  highly  important  to  the  present  and  future  of  our  race. — Preface. 

SUMMAKY     OF     CONTENTS. 

PART!.  General  Dietetics.  CHAP.  I.  Theories  of  Dietetics.  II.  On  the  Choice  of  Food.  III. 
On  the  Preparation  of  Food.  IV.  On  Digestion  and  Nutrition. 

PART  II.  Special  Dietetics  of  Health.  CHAP.  I.  Regimen  of  Infancy  and  Motherhood.  II. 
Regimen  of  Childhood  and  Youth.  III.  Commercial  Life.  IV.  Literary  and  Professional  Life. 
V.  Noxious  Trades.  VI.  Athletic  Training.  VII.  Hints  for  Healthy  Travellers.  VIII.  Effects 
of  Climate.  IX.  Starvation,  Poverty,  and  Fasting.  X.  The  Decline  of  Life.  XI.  Alcohol. 

PART  III.  Dietetics  in  Sickness.  CHAP.  I.  Dietetics  and  Regimen  in  Acute  Fevers.  II.  The 
Diet  and  Regimen  of  certain  other  Inflammatory  States.  III.  The  Diet  and  Regimen  of  Weak 
Digestion.  IV.  Gout  and  Rheumatism.  V.  Gravel,  Stone,  Albuminuria,  and  Diabetes.  VI. 
Deficient  Evacuation.  VII.  Nerve  Disorders.  VIII.  Scrofula,  Rickets,  and  Consumption.  IX. 
Diseases  of  Heart  and  Arteries. 


HENRY  C.  LEA'S  PUBLICATIONS. 


IT 


J?LINT  (AUSTIN),  M.D., 

~-  Professor  of  the  Principles  and  Practice  of  Medicine  in  Bellevue  Hospital  Med.  College,  N.  Y. 

A  PRACTICAL  TREATISE  ON  THE  DIAGNOSIS,  PATHOLOGY, 

AND  TREATMENT  OF  DISEASES  OF  THE  HEART.     Second  revised  and  enlarged 
edition.     In  one  octavo  volume  of  550  pages,  with  a  plate,  cloth,  $4. 

Dr.  Flint  chose  a  difficult  subject  for  his  researches,  i  able  for  purposes  of  illustration,  in  connection  with 
and  has  shown  remarkable  powers  of  observation  I  cases  which  have  been  reported  by  other  trustworthy 
and  reflection,  as  well  as  great  industry,  in  his  treat-    observers. — Brit,  and  For.  Med.-Ghirurg.  Review. 
ment  of  it.     His  book  must  be  considered  the  fullest 
and  clearest  practical  treatise  on  those  subjects,  and 
should  be  in  the  hands  of  all  practitioners  and  stu- 
dents.   It  is  a  credit  to  American  medical  literature. 
— Amer.  Journ.  of  the  Med.  Sciences,  July,  1860. 


We  question  the  fact  of  any  recent  American  author 
in  our  profession  being  more  extensively  known,  or 
more  deservedly  esteemed  in  this  country  than  Dr. 


In  regard  to  the  merits  of  the  work,  we  have  no 
hesitation  in  pronouncing  it  full,  accurate,  and  judi- 
cious. Considering  the  present  state  of  science,  such 
a  work  was  much  needed.  It  should  be  in  the  hands 
of  every  practitioner. — Chicago  Med.  Journ. 


With  more  than  pleasure  do  we  hail  the  advent  of 
this  work,  for  it  fills  a  wide  gap  on  the  list  of  text- 


Flint.     We  willingly  acknowledge  his  success,  more    books  for  our  schools,  and  is,  for  the  practitioner,  the 


particularly  in  the  volume  on  diseases  of  the  heart, 
In  making  an  extended  personal  clinical  study  avail- 


most  valuable  practical  work  of  its  kind. — N.  0.  Med. 
News. 


TjY  THE  SAME  AUTHOR. 

A  PRACTICAL  TREATISE  ON  THE  PHYSICAL  EXPLORA- 
TION OF  THE  CHEST  AND  THE  DIAGNOSIS  OF  DISEASES  AFFECTING  THB 
RESPIRATORY  ORGANS.  Second  and  revised  edition.  In  one  handsome  octavo  volume 
of  595  pages,  cloth,  $4  50. 


Dr.  Flint's  treatise  Is  one  of  the  most  trustworthy 
guides  which  we  can  consult.  The  style  is  clear  and 
distinct,  and  is  also  concise,  being  free  from  that  tend- 
ency to  over-refinement  and  unnecessary  minuteness 
which  characterizes  many  works  on  the  same  sub- 
ject.— Dublin  Medical  Press,  Feb.  6,  1867. 

The  chapter  on  Phthisis  is  replete  with  Interest; 
and  his  remarks  on  the  diagnosis,  especially  in  the 
early  stages,  are  remarkable  for  their  acumen  and 
great  practical  value.  Dr.  Flint's  style  is  clear  and 
elegant,  and  the  tone  of  freshness  and  originality 


which  pervades  his  whole  work  lend  an  additional 
force  to  its  thoroughly  practical  character,  which 
cannot  fail  to  obtain  for  it  a  place  as  a  standard  work 
on  diseases  of  the  respiratory  system. — London 
Lancet,  Jan.  IP,  1867. 

This  is  an  admirable  book.  Excellent  in  detail  and 
execution,  nothing  better  could  be  desired  by  the 
practitioner.  Dr.  Flint  enriches  his  subject  with 
much  solid  and  not  a  little  original  observation.— 
Ranking 's  Abstract,  Jan.  1867. 


(HENRY  WILLIAM),  M.  D., 

.  Physician  to  St.  George's  Hospital,  London. 

ON  DISEASES  OF  THE   LUNGS   AND   AIR-PASSAGES.    Their 

Pathology,  Physical  Diagnosis,  Symptoms,  and  Treatment.     From  the  second  and  revised 
English  edition.     In  one  handsome  octavo  volume  of  about  500  pages,  cloth,  $3  50. 


7LLIAMS  (G.  J.  B.),  M.D., 

Senior  Consulting  Physician  to  the  Hospital  for  Consumption,  Brompton,  and 

S  (CHARLES  T.),  M.D., 

Physician  to  the  Hospital  for  Consumption. 

PULMONARY  CONSUMPTION;  Its  Nature,  Varieties,  and  Treat- 

ment.     With  an  Analysis  of  One  Thousand  Cases  to  exemplify  its  duration.     In  one  neat 
octavo  volume  of  about  350  pages,  cloth,  $2  50.     (Lately  Published.) 


He  can  still  speak  from  a  more  enormous  experi- 
ence, and  a  closer  study  of  the  morbid  processes  in- 
volved in  tuberculosis,  than  most  living  men.  He 
owed  it  to  himself,  and  to  the  importance  of  the  sub- 
ject, to  embody  his  views  in  a  separate  work,  and 
we  are  glad  that  he  has  accomplished  this  duty. 


After  all,  the  grand  teaching  which  Dr  Williams  has 
for  the  profession  is  to  be  found  in  his  therapeutical 
chapters,  and  in  the  history  of  individual  cases  ex- 
tended, by  dint  of  care,  over  ten,  twenty,  thirty,  and 
sven  forty  years. — London  Lancet,  Oct.  21, 1871. 


LA  ROCHE  ON  PNEUMONIA. 

of  600  pages .    Price  $3  00. 
SMITH  ON  CONSUMPTION  ;  ITS  EARLY  AND  RE 

MEDIABLE  STAGES.     1  vol.  8vo.,  pp.  254.    $2  26 


1  vol.  8vo.,  cloth,  i  WALSHE  ON  THE  DISEASES  OF  THE  HEART  AND 
GREAT  VESSELS.  Third  American  edition.  IB 
1  vol.  8vo..  420  pp.,  cloth.  $3  00. 


WX  ( WILSON],  M.D., 

Holme  Prof,  of  Clinical  Med.,  University  Coll.,  London. 

THE  DISEASES  OF  THE  STOMACH:  Being  the  Third  Edition  of 

the  "Diagnosis  and  Treatment  of  the  Varieties  of  Dyspepsia."     Revised  and  Enlarged. 
With  illustrations.     In  one  handsome  octavo  volume,  cloth,  $2  00.     (Now  Ready.) 


Dr.  Fox  has  put  forth  a  volume  of  uncommon  ex- 
cellence, which  we  feel  very  sure  will  take  a  high 


rauk  among  works  that  treat  of  the  stomach. — Am. 
Practitioner,  March,  1873. 


TyRINTON  (WILLIAM),  M.D.,  F.R.S. 
^LECTURES  ON  THE  DISEASES  OF  THE  STOMACH;  with  an 

Introduction  on  its  Anatomy  and  Physiology.  From  the  second  and  enlarged  London  edi- 
tion. With  illustrations  on  wood  In  one  handsome  octavo  volume  of  about  300  pages, 
cloth,  $3  25. 


18 


HENRY  C.  LEA'S  PUBLICATIONS — (Practice  of  Medicine). 


DOBERTS  (  WILLIAM],  M.  D., 

*«'  Lecturer  on  Medicine  in  the  Manchester  School  of  Medicine,  Ac. 

A  PRACTICAL  TREATISE   ON  URINARY  AND   RENAL   DIS- 

EASES,  including  Urinary  Deposits.  Illustrated  by  numerous  cases  and  engravings.  Sec- 
ond American,  from  the  Second  Revised  and  Enlarged  London  Edition.  In  one  large 
and  handsome  octavo  volume  of  616  pages,  with  a  colored  plate  ;  cloth,  $4  50.  (Lately 
Published.) 

The  author  has  subjected  this  work  to  a  very  thorough  revision,  and  has  sought  to  embody  in 
it  the  results  of  the  latest  experience  and  investigations.  Although  every  effort  has  been  made 
to  keep  it  within  the  limits  of  its  former  size,  it  has  been  enlarged  by  a  hundred  pages,  many 
new  wood-cuts  have  been  introduced,  and  also  a  colored  plate  representing  the  appearance  of  the 
different  varieties  of  urine,  while  the  price  has  been  retained  at  the  former  very  moderate  rate. 

The  plan,  it  will  thus  be  seen,  is  very  complete,     diseases  we  have  examined     It  Is  peculiarly  adapted 

to  the  wants  of  the  majority  of  American  practltion- 


and  the  manner  in  which  it  has  been  carried  out  is 
in  the  highest  degree  satisfactory.  The  characters 
of  the  different  deposits  are  very  well  described,  and 
the  microscopic  appearances  they  present  are  illus- 
trated by  numerous  well  executed  engravings.  It 
only  remains  to  us  to  strongly  recommend  to  our 
readers  Dr.  Roberts's  work,  as  containing  an  admira- 
ble rfsume  of  the  present  state  of  knowledge  of  uri- 
nary diseases,  and  as  a  safe  and  reliable  guide  to  the 
clinical  observer. — Edin.  Med.  Jour. 


ers  from  its  clearness  and  simple  announcement  of  the 
facts  in  relation  to  diagnosis  and  treatment  of  urinary 
disorders,  and  contains  in  condensed  form  the  investi- 
gations of  Bence  Jones,  Bird,  Beale,  Hassall,  Prout, 
and  a  host  of  other  well-known  writers  upon  thin  sub- 
ject. The  characters  of  urine,  physiological  and  pa- 
thological, as  indicated  to  the  naked  eye  as  well  as  by 
microscopical  and  chemical  investigations,  are  con- 
cisely represented  both  by  description  and  by  well 
executed  engravings. — Cincinnati  Journ.  of  Med. 


-DASHAM  (W.R.),  M.D., 

•*-*  Senior  Physician  to  the  Westminster  Hospital,  &c. 

RENAL  DISEASES :  a  Clinical  Guide  to  their  Diagnosis  and  Treatment. 

With  illustrations.     In  one  neat  royal  12mo.  volume  of  304  pages,  cloth,  $2  00. 


The  chapters  on  diagnosis  and  treatment  are  very 

food,  and  the  student  and  young  practitioner  will 
nd  them  full  of  valuable  practical  hints.  The  third 
part,  on  the  urine,  is  excellent,  and  we  cordially 
recommend  its  perusal.  The  author  has  arranged 
his  matter  in  a  somewhat  novel,  and,  we  think,  use- 
ful form.  Here  everything  can  be  easily  found,  and, 
what  is  more  important,  easily  read,  for  all  the  dry 


details  of  larger  books  here  acquire  a  new  interest 
from  the  author's  arrangement.  This  part  of  the 
book  is  full  of  good  work. — Brit,  and  For.  Medico- 
Ghirurgical  Review,  July,  1870. 

The  easy  descriptions  and  compact  modes  of  state- 
ment render  the  book  pleasing  and  convenient. — Am. 
Journ.  Med.  Sciences,  July,  1870. 


INCOLN  (D.  P.).  M.D., 

'  Physician  to  the  Department  of  Nervous  Diseases,  Boston  Dispensary. 

ELECTRO  THERAPEUTICS;  A.  Concise  Manual  of  Medical  Electri- 
city.    Inone  very  neat  royal  12mo.  volume,  cloth,  with  illustrations,  $1  50.     (Just  Ready.) 


The  work  is  convenient  in  size,  its  descriptions  of 
methods  and  appliances  are  sufficiently  complete  for 
the  general  practitioner,  and  the  chapters  on  Electro- 
physiology  and  diagnosis  are  well  written  and  read- 
able. For  those  who  wish  a  handy-book  of  directions 
for  the  employment  of  galvanism  in  medicine,  this 
will  serve  as  a  very  good  and  reliable  guide. — New 
Remedies,  Oct.  1874. 

It  is  a  well  written  work,  and  calculated  to  meet 
the  demands  of  the  busy  practitioner.  It  contains 
the  latest  researches  in  this  important  branch  of  med- 
icine.— Peninsular  Journ.  of  Med.,  Oct.  1874. 

Eminently  practical  in  character.  It  will  amply 
repay  any  one  for  a  careful  perusal. — Leavenworth 
Med.  Herald,  Oct.  1874. 


This  little  book  is,  considering  its  size,  one  of  the 
very  best  of  the  English  treatises  on  its  subject  that 
has  come  to  our  notice,  possessing,  among  others,  the 
rare  merit  of  dealing  avowedly  and  actually  with 
principles,  mainly,  rather  than  with  practical  details, 
thereby  supplying  a  real  want,  instead  of  helping 
merely  to  flood  the  literary  market.  Dr.  Lincoln's 
style  is  usually  remarkably  clear,  and  the  whole 
book  is  readable  and  interesting. — Boston  Med.  and 
Sura.  Journ.,  July  23,  1874. 

We  have  here  in  a  small  compass  a  great  deal  of 
valuable  information  upon  the  subject  of  Medical 
Electricity. — Canada  Med.  and  Surg.  Journ.,  Nov. 
1874. 


(HENRY), 

Prof,  of  Surgery  at  the  Royal  College  of  Surgeons  of  England,  etc. 

LECTURES  ON  SYPHILIS  AND  ON  SOME  FORMS  OF  LOCAL 

DISEASE  AFFECTING  PRINCIPALLY  THE  ORGANS  OF  GENERATION.     In  one 
handsome  octavo  volume. 

GOKfTEIsTTS. 

LECTURES. I.,  II.,  III.  General. — IV.  Treatment  of  Syphilis — V.  Treatment  of  Particular 
and  Modified  Syphilitic  Affections — VI.  Second  Stage  of  Lues  Venerea;  Treatment — VII.  Lo- 
cal Suppurating  Venereal  Sore  ;  Syphilization  ;  Lymphatic  Absorption  ;  Physiological  Absorp- 
tion ;  Twofold  Inoculation — VIII.  Urethral  Discharges  :  different  kinds;  Treatment;  Conclu- 
sions of  Hunter  and  Ricord — IX.  Prostatic  Discharges — X.  Lymphatic  Absorption  continued  ; 
Local  Affections  ;  Warts  and  Excrescences. 


DIPHTHERIA  ;  its  Nature  and  Treat -nent,  with  an 
account  of  the  History  of  its  Prevalence  in  vari- 
ous Countries.  By  D.  D.  SLADE,  M.D.  Second  and 
revised  edition.  In  one  neat  royal  12mo.  volume, 
cloth,  $1  25.  ] 

LECTURES  ON  THE  STUDY  OF  FEVER.      By  A.  ! 
HUDSOJT,  M.D. ,  M.K.I. A.,  Physician  to  the  Meath 
Hospital.    la  one  vol.  8vo.,  cloth,  $2  50. 


A  TREATISE  ON  FEVER.  By  ROBERT  D  LYONS, 
K  C  C.  In  one  octavo  volume  of  362  pages,  cloth, 
$2  23. 

CLINICAL  OBSERVATIONS  ON  FUNCTIONAL 
NERVOUS  DISOKDERS  BvC.  HANDPIELD  JONKS, 
M.D.,  Physician  to  St.  Mary's  Hospital,  &c.  Sec- 
ond American  Edition.  In  one  handsome  octavo 
volume  of  348  pages,  cloth,  $3  25.  J 


HENRY  C.  LEA'S  PUBLICATIONS — (  Venereal  Diseases,  etc.). 


19 


f>UMSTEAD  (FREEMAN  J.},  M.D., 

•*-*        Professor  of  Venereal  Diseases  at  the  Col.  of  Phys.  and  Surg.,  New  York,  Ac. 

THE  PATHOLOGY  AND  TREATMENT  OF  VENEREAL  DIS- 

EASES.  Including  the  results  of  recent  investigations  upon  the  subject.  Third  edition, 
reTised  and  enlarged,  with  illustrations.  In  one  large  and  handsome  octavo  volume  of 
over  700  pages,  cloth,  $5  00  ;  leather,  $fi  00. 

In  preparing  this  standard  work  again  for  the  press,  the  author  has  subjected  it  to  a  very 
thorough  revision.  Many  portions  have  been  rewritten,  nnd  much  new  matter  added,  in  order  to 
bring  it  completely  on  a  level  with  the  most  advanced  condition  of  syphilography,  but  by  careful 
compression  of  the  text  of  previous  editions,  the  work  has  been  increased  by  only  sixty -four  pages. 
The  labor  thus  bestowed  upon  it,  it  is  hoped,  will  insure  for  it  a  continuance  of  its  position  as  a 
complete  and  trustworthy  guide  for  the  practitioner. 

It  ia  the  most  complete  book  with  which  we  are  ac-  |  much  special  commendation  as  if  its  predecessors  had 
qaainted  in  the  language.  The  latest  views  of  the  not  been  published.  As  a  thoroughly  practical  book 
best  authorities  are  pat  forward,  and  the  information  j  on  a  class  of  diseases  which  form  a  large  share  of 
Is  well  arranged— a  great  point  for  the  student,  and  :  nearly  every  physician's  practice,  the  volume  before 
still  more  for  the  practitioner.  The  subjects  of  vis-  us  is  by  far  the  best  of  which  we  have  knowledge. — 
eeral  syphilis,  syphilitic  affections  of  the  eyes,  and  j  N.  7.  Medical  Gazette,  Jan.  28,  1871. 
the  treatment  of  syph.Jis  by  repeated  inoculations  are  i  u  jg  rare  in  the  history  of  medicine  to  And  anyone 
very  fully  discussed.— London  Lancet,  Jan.  7,  1871.  ;  book  which  contains  all  that  a  practitioner  needs  to 

Dr.  Bumstead's  work  is  already  so  universally  know;  while  the  possessor  of  "Bumstead  on  Vene- 
known  as  the  best  treatise  in  the  English  language  on  j  real"  has  no  occasion  to  look  outside  of  its  covers  for 
venereal  diseases,  that  It  may  seem  almost  superflu-  anything  practical  connected  with  the  diagnosis,  his- 
oas  to  say  more  of  it  than  that  a  new  edition  has  been  tory,  or  treatment  of  these  affections. — If.  T.  Medical 
Issued.  But  the  author's  industry  has  rendered  this  '  Journal,  March,  1871. 
aew  edition  virtually  a  new  work,  and  so  merits  as 


riULLERIER  (A.),  and 

v         Surgeon  to  the  Hdpital  du  Jfidi. 


~D  UMSTEA D  (FREE MA  N  J. ), 

-*-'       Professor  of  Venerea  I  Diseases  in  the.  College  of 
Physicians  and  Surgeons,  If.  T. 


AN  ATLAS  OF  VENEREAL  DISEASES.     Translated  and  Edited  by 

FREEMAN  J.  BUMSTEAD.  In  one  large  imperial  4to.  volume  of  328  pages,  double-columns, 
with  26  plates,  containing  about  150  figures,  beautifully  colored,  many  of  them  the  size  of 
life;  strongly  bound  in  cloth,  $17  00  ;  also,  in  five  parts,  stout  wrappers  for  mailing,  at  $3 
per  part. 

Anticipating  a  very  large  sale  for  this  work,  it  is  offered  at  the  very  low  price  of  THREE  DOL- 
LARS a  Part,  thus  placing  it  within  the  reach  of  all  who  are  interested  in  this  department  of  prac- 
tice.    Q-entlemen  desiring  early  impressions  of  the  plates  would  do  veM  to  order  it  without  delay. 
A  specimen  of  the  plates  and  text  sent  free  by  mail,  on  receipt  of  25  cents. 


We  wish  for  once  that  our  province  was  not  rextrict- 
•  d  to  methods  of  treatment,  that  we  might  say  some- 
thing of  the  exquisite  colored  plates  in  this  volume. 
—London  Practitioner,  May,  1869. 

As  a  whole,  it  teaches  all  that  can  be  taught  by 
means  of  plates  and  print. — London  Lancet,  March 
13,  18«8. 


on  this  continent. — Canada  Med.  Journal,  March,  '69. 

The  practitioner  who  desires  to  understand  this 
branch  of  medicine  thoroughly  should  obtain  this, 
the  most  complete  and  best  work  ever  published. — 
Dominion  Med.  Journal,  May,  1869. 

This  is  a  work  of  master  hands  on  both  sides.  M. 
Cnllerier  is  scarcely  second  to,  we  think  we  may  truly 
»ay  is  &  peer  of  the  illustrious  and  venerable  Ricord, 
while  in  this  country  we  do  not  hesitate  to  say  that 
Dr.  Bnmstead,  as  an  authority,  is  without  a  rival 
Assuring  our  readers  that  these  illustrations  tell  the 
whole  history  of  venereal  disease,  from  its  inception 
to  its  end,  we  do  not  know  a  single  medical  work, 


which  for  its  kind  is  more  necessary  for  them  to  have. 
— Calif  )rnia  Med.  Gazette,  March,  1869. 

The  most  splendidly  illustrated  work  in  the  lan- 
guage, and  in  our  opinion  far  more  usefnl  than  the 
French  original. — Am.  Journ.  Jfed.  Sciences,  Jan. '69. 

The  fifth  and  concluding  number  of  this  magnificent 
work  has  reached  us,  and  we  have  no  hesitation  in 


Superior  to  anything  of  the  kind  ever  before  issued  , -saying  that  its  illustrations  surpass  those  of  previous 


numbers.—  Boston  Med.  and  Surg.  Journal,  Jan.  14, 
1869. 

Other  writers  besides  M.  Cullerier  have  given  us  a 
good  account  of  the  diseases  of  which  he  treats,  but 
no  one  has  furnished  us  with  such  a  complete  series 
of  illustrations  of  the  venereal  diseases.  There  is, 
however,  an  additional  interest  and  value  possessed 
by  the  volume  before  us  ;  for  it  is  an  American  reprint 
and  translation  of  M.  Cullerier's  work,  with  inci- 
dental remarks  by  one  of  the  most  eminent  American 
syphilographers,  Mr.  Bnmstead.  —  Brit,  and  For. 
Medico-Chir.  Review,  July,  1869. 


(BERKELEY), 

Surgeon  to  the  Lock  Hospital,  London. 

ON  SYPHILIS  AND  LOCAL 

one  handsome  octavo  volume  ;  cloth,  $3 

Bringing,  as  it  does,  the  entire  literature  of  the  dis- 
ease down  to  the  present  day,  and  giving  with  great 
ability  the  results  of  modern  research,  it  is  in  every 
respect  a  most  desirable  work,  and  one  which  should 
find  a  place  in  the  library  of  every  surgeon. — Cali- 
fornia Jfed.  Gazette,  Jane,  1869. 

Considering  the  scope  of  the  book  and  the  careful 
attention  to  the  manifold  aspects  and  details  of  its 
subject,  it  is  wonderfully  concise  All  these  qualities 
render  it  an  especially  valuable  book  to  the  beginner, 


CONTAGIOUS  DISORDERS.    In 

25. 

to  whom  we  would  most  earnestly  recommend  It* 
study ;  while  it  is  no  less  usefnl  to  the  practitioner.— 
St.  Louis  Med.  and  Surg.  Journal,  May,  1869. 

The  most  convenient  and  ready  book  of  reference 
we  have  met  with.—  If.  Y.  Med.  Record,  May  1,1869. 

Most  admirably  arranged  for  both  student  and  prac- 
titioner, no  other  work  on  the  subject  equal*  it ;  it  i» 
more  simple,  more  easily  studied. — Buffalo  Med.  and 
Surg.  Journal,  March,  1869. 


VEISSL  (H.),  M.D. 

A  COMPLETE  TREATISE  ON  VENEREAL  DISEASES.    Trans- 

lated  from  the  Second  Enlarged  German  Edition,  by  FREDERIC  R.  STURGIS,  M.D     In  one 
octavo  volume,  with  illustrations.      (Preparing.) 


20 


HENRY  C.  LEA'S  PUBLICATIONS — (Diseases  of  the  Skin). 


WILSON  (ERASMUS),  F.R.S. 

ON  DISEASES  OP  THE  SKIN.    With  Illustrations  on  wood.    Sev- 

enth  American,  from  the  sixth  and  enlarged  English  edition.     In  one  large  octavo  volume 
of  over  800  pages,  $5. 

A  SERIES  OF  PLATES  ILLUSTRATING  "WILSON  ON  DIS- 
EASES OF  THE  SKIN;"  consisting  of  twenty  beautifully  executed  plates,  of  which  thir- 
teen are  exquisitely  colored,  presenting  the  Normal  Anatomy  and  Pathology  of  the  Skin, 
and  embracing  accurate  representations  of  about  one  hundred  varieties  of  disease,  most  of 
them  the  size  of  nature.  Price,  in  extra  cloth,  $5  50. 

Also,  the  Text  and  Plates,  bound  in  one  handsome  volume.     Cloth,  $10. 


No  one  treating  skin  diseases  should  be  without 
a  copy  of  this  standard  work. —  Canada  Lancet. 

We  can  safely  recommend  it  to  the  profession  at 
the  best  work  on  the  subject  now  in  existence  ID 
the  English  language. — Medical  Times  and  Gazette 

Mr.  Wilson's  volume  is  an  excellent  digest  of  th« 
actual  amount  of  knowledge  of  cutaneous  diseases  : 
it  includes  almost  every  fact  or  opinion  of  importance 
connected  with  the  anatomy  and  pathology  of  th« 
skin. — British  and  Foreign  Medical  Review. 

Such  a  work  as  the  one  before  us  is  a  most  capital 


*nd  acceptable  help.  Mr.  Wilson  has  long  been  held 
*s  high  authority  in  this  department  of  medicine,  and 
his  book  on  diseases  of  the  skin  has  long  been  re- 
garded as  one  of  the  best  text-books  extant  on  the 
subject.  The  present  edition  is  carefully  prepared, 
and  brought  up  in  its  revision  to  the  present  time.  In 
this  edition  we  have  also  included  the  beautiful  series 
of  plates  illustrative  of  the  text,  and  in  the  last  edi- 
;ion  published  separately.  There  are  twenty  of  these 
plates,  nearly  all  of  them  colored  to  nature,  and  ex- 
hibiting with  great  fidelity  the  various  groups  ot 
diseases. — Cineinnati  Lancet. 


>T  THE  SAME  AUTHOR.  

THE  STUDENT'S  BOOK  OF  CUTANEOUS  MEDICINE  and  Dis- 

BASES  OF  THE  SKIN.    In  one  very  handsome  royal  12mo.  volume.   $350. 


J^ELIGAN  (J.  MOORE],  M.D.,  M.R.I. A. 

A    PRACTICAL    TREATISE    ON    DISEASES    OF    THE    SKIN. 

Fifth  American,  from  the  second  and  enlarged  Dublin  edition  by  T.  W.  Belcher,  M.  D. 
In  one  neat  royal  12mo.  volume  of  462  pages,  cloth,  $2  25. 

Fully  equal  to  all  the  requirements  of  students  and 


young  practitioners. — Dublin  Med.  Press. 

Of  the  remainder  of  the  work  we  have  nothing  be- 
yond unqualified  commendatioijfto  offer.  It  is  so  far 
the  most  complete  one  of  its  size  that  has  appeared, 
and  for  the  student  there  can  be  none  which  can  com- 


their  value  justly  estimated;  in  a  word,  the  work  i* 
fully  up  to  the  times,  and  is  thoroughly  stocked  with 
most  valuable  information. — New  York  Med.  Record, 
Jan.  15,  1867. 

The  most  convenient  manual  of  diseases  of  the 
skin  that  can  be  procured  by  the  student. — Chicago 
Med.  Journal,  Dec.  1866. 


pare  with  it  in  practical  value.  All  the  late  disco- 
veries in  Dermatology  have  been  duly  noticed,  and 
JjY  THE  SAME  AUTHOR.  

ATLAS   OF   CUTANEOUS   DISEASES.     In  one  beautiful  quarto 

voljume,  with  exquisitely  colored  plates,  Ac.,  presenting  about  one  hundred  varieties  of 
disease.     Cloth,  $5  50. 

The  diagnosis  of  eruptive  disease,  however,  under  I  inclined  to  consider  it  a  very  superior  work,  corn- 
all  circumstances,  is   very  difficult.     Nevertheless,  |  bining  accurate  verbal  description  with  sound  view* 


Dr.  Neligan  has  certainly,  "as  far  as  possible,"  given 
a  faithful  and  accurate  representation  of  this  class  of 
diseases,  and  there  can  be  no  doubt  that  these  plates 
will  be  of  great  use  to  the  student  and  practitioner  in 
drawing  a  diagnosis  as  to  the  class,  order,  and  species 
to  which  the  particular  case  may  belong.  While 
looking  over  the  "Atlas"  we  have  been  induced  to 
examine  also  the  "Practical  Treatise,"  and  we  are 


of  the  pathology  and  treatment  of  eruptive  diseases. 
— Glasgow  Med.  Journal. 

A  compend  which  will  very  much  aid  the  practi- 
tioner in  this  difficult  branch  of  diagnosis.  Taken 
with  the  beautiful  plates  of  the  Atlas,  which  are  re- 
markable for  their  accuracy  and  beauty  of  coloring, 
it  constitutes  a  very  valuable  addition  to  the  library 
of  a  practical  man. — Bvfalo  Med.  Journal. 


TJILLIER  (THOMAS),  M.D., 

•*"*-  Physician  to  the  Skin  Department  of  University  College  Hospital,  Ac. 

HAND-BOOK  OF  SKIN  DISEASES,  for  Students  and  Practitioners. 

Second  American  Edition.     In  one  royal  12mo.  volume  of  358  pp.     With  Illustrations. 
Cloth,  $2  25. 


We  can  conscientiously  recommend  it  to  the  stu- 
dent; the  style  is  clear  and  pleasant  to  read,  the 
matter  is  good,  and  the  descriptions  of  disease,  with 
the  modes  of  treatment  recommended,  are  frequently 
Illustrated  with  well-recorded  cases. — London  Med. 
Times  and  Gazette,  April  1,  1865. 


It  is  a  concise,  plain,  practical  treatise  on  the  vari- 
ous diseases  of  the  skin  ;  just  such  a  work,  iudeoii, 
as  was  much  needed,  both  by  medical  students  and 
practitioners.  —  Chicago  Medical  Examiner,  May, 


1865. 


A  NDERSON  (McCALL),  M.D., 

-^-*-  Physician  to  the  Dispensary  for  Skin  Diseases,  Glasgow,  &c. 

ON  THE  TREATMENT  OF  DISEASES  OF  THE  SKIN.    With  an. 

Analysisof  Eleven  Thousand  Consecutive  Cases.  In  one  vol.  8vo.  $1.   (Lately  Published.) 


GTJERSANT'S  SURGICAL  DISEASES  OF  INFANTS 
AND  CHILDREN.  Translated  by  R.  J.  DU.VQLI- 
BON,  M.D.  1  vol.  8vo.  Cloth,  $2  50. 


D15WEES  ON  THE  PHYSICAL  AND  MET>Tf!AL 
TREATMENT  oy  CHILDREN  Klaventh  editioa. 
1  voi.  Bvo.  of  548  pages.  Cloth,  $2  80. 


HENRY  C.  LEA'S  PUBLICATIONS — (Diseases  6f  Children). 


&MITH  (J.  LE  WIS),  M.  D., 

*-J  Professor  of  Morbid  Anatomy  in  the  Be.llevue  Hospital  Med.  College,  If.  T. 

A  COMPLETE  PRACTICAL  TREATISE  ON  THE  DISEASES  OP 

CHILDREN.    Second  Edition,  revised  and  greatly  enlarged.     In  one  handsome  octavo 
volume  of  742  pages,  cloth,  $5;  leather,  $6.     (Lately  Published.) 
FROM  THE  PREFACE  TO  THE  SECOND  EDITION. 

In  presenting  to  the  profession  the  second  edition  of  his  work,  the  author  gratefully  acknow- 
ledges the  favorable  reception  accorded  to  the  first.  He  has  endeavored  to  merit  a  continuance 
of  this  approbation  by  rendering  the  volume  much  more  complete  than  before.  Nearly  twenty 
additional  diseases  have  been  treated  of,  among  which  may  be  named  Diseases  Incidental  to 
Birth,  Rachitis,  Tuberculosis,  Scrofula,  Intermittent,  Remittent,  and  Typhoid  Fevers,  Chorea, 
and  the  various  forms  of  Paralysis.  Many  new  formulae,  which  experience  has  shown  to  be 
useful,  have  been  introduced,  portions  of  the  text  of  a  less  practical  nature  have  been  con- 
densed, and  other  portions,  especially  those  relating  to  pathological  histology,  have  been 
rewritten  to  correspond  with  recent  discoveries.  Every  effort  has  been  made,  however,  to  avoid 
an  undue  enlargement  of  the  volume,  but,  notwithstanding  this!  and  an  increase  in  the  size  of 
the  page,  the  number  of  pages  has  been  enlarged  by  more  than  one  hundred. 

227  WEST  49iH  STREET,  NEW  YORK,  April,  1872. 

The  work  will  be  found  to  contain  nearly  one-third  more  matter  than  the  previous  edition,  and 
it  is  confidently  presented  as  in  every  respect  worthy  to  be  received  as  the  standard  American 
text-book  on  the  subject. 


Eminently  practical  as  well  as  judicious  in  its 
teachings. — Cincinnati  Lancet  and  Obs.,  July,  1872. 

A  standard  work  that  leaves  little  to  be  desired. — 
Indiana  Journal  of  Medicine,  July,  1872. 

We  know  of  no  book  on  this  subject  that  we  can 
more  cordially  recommend  to  the  medical  student 
and  the  practitioner. — Cincinnati  Clinic,  June  29,  '72. 


We  regard  it  as  superior  to  any  other  single  work 
on  the  diseases  of  infancy  and  childhood. — Detroit 
Rev.  of  Med.  and  Pharmacy,  Aug.  1872. 

We  confess  to  increased  enthusiasm  in  recommend- 
ing this  second  edition. — St.  Louis  Med.  and  Surg. 
Journal,  Aug.  1872. 


riONDIE  (D.  FRANCIS),  M.D. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN. 

Sixth  edition,  revised  and  augmented.     In  one  large  octavo  volume  of  nearly  800  closely- 
printed  pages,  cloth,  $5  25  ;  leather,  $6  25. 


The  present  edition,  which  is  the  sixth,  is  fully  up 
to  the  times  in  the  discussion  of  all  those  points  in  the 
pathology  and  treatment  of  infantile  diseases  which 
have  been  brought  forward  by  the  German  and  French 


teachers.  As  a  whole,  however,  the  work  is  the  best 
American  one  that  we  have,  and  in  its  special  adapta- 
tion to  American  practitioners  it  certainly  has  no 
equal.  —  New  York  Med.  Record,  March  2,  1868. 


WEST  (CHARLES),  M.D., 

Physician  to  the  Hospital  for  Sick  Children,  ice. 

LECTURES  ON  THE  DISEASES  OP  INFANCY  AND  CHILD- 
HOOD. Fifth  American  from  the  sixth  revised  and  enlarged  English  edition.  In  one  large 
and  handsome  octavo  volume  of  678  pages.  Cloth,  $4  50  ;  leather,  $5  50.  (Just  Issued.) 

The  continued  demand  for  this  work  on  both  sides  of  the  Atlantic,  and  its  translation  int*  Ger- 
man, French,  Italian,  Danish,  Dutch,  and  Russian,  show  that  it  fills  satisfactorily  a  want  exten- 
sively felt  by  the  profession.  There  is  probably  no  man  living  who  can  speak  with  the  authority 
derived  from  a  more  extended  experience  than  Dr.  West,  and  his  work  now  presents  the  results  of 
nearly  2000  recorded  cases,  and  600  post-mortem  examinations  selected  from  among  nearly  40,000 
cafes  which  have  passed  under  his  care.  In  the  preparation  of  the  present  edition  he  has  omitted 
much  that  appeared  of  minor  importance,  in  order  to  find  room  for  the  introduction  of  additional 
matter,  and  the  volume,  while  thoroughly  revised,  is  therefore  not  increased  materially  in  size. 

Of  all  the  English  writers  on  the  diseases  of  chil- I  living  authorities  in  the  difficult  department  of  medi- 
dren,  there  is  no  one  so  entirely  satisfactory  to  us  as  J  cal  science  in  which  he  is   most  widely  known.— 
Dr.  West.    For  years  we  have  held  his  opinion  as  I  Boston  Med.  and  Surg.  Journal. 
Judicial,  and  have  regarded  him  as  one  of  the  highest  | 


BY  THE  SAME  AUTHOR.    (Lately Issued.) 

ON  SOME  DISORDERS  OF  THE  NERVOUS  SYSTEM  IN  CHILD- 

HOOD;  being  the  Lumleian  Lectures  delivered  at  the  Royal  College  of  Physicians  of  Lon- 
don, in  March,  1871.     In  one  volume,  small  12mo.,  cloth,  $1  00. 

SMITH  (EUSTACE),  M.  D., 

Physician  to  the  Northwest  London  Free  Dispensary  for  Sick  Children. 

A  PRACTICAL  TREATISE  ON   THE  WASTING  DISEASES  OF 

INFANCY  AND  CHILDHOOD.  Second  American,  from  the  second  revised  and  enlarged 
English  edition.  In  one  handsome  octavo  volume,  cloth,  $2  50.  (Lately  Itsiied.) 
This  is  in  every  way  an  admirable  book.  The  scribed  as  a  practical  handbook  of  the  common  dis- 
eases of  children,  so  numerous  are  the  affections  con- 
sidered either  collaterally  or  directly.  We  are 
acquainted  with  no  safer  guide  to  the  treatment  of 


modest  title  which  the  author  has  chosen  for  i  t  scarce- 
ly conveys  an  adequate  idea  of  the  many  subjects 
npoa  which  it  treats.  Wasting  is  so  constant  an  at- 
teudant  upon  the  maladies  of  childhood,  that  a  trea- 


children's  diseases,  and  few  works  give  the  insight 


Use  upon  the  wasting  diseases  of  children  must  neces-  i  into  the  physiological  and  other  peculiarities  of  chil- 
•arily  embrace  the  consideration  of  many  affections  j  dren  that  Dr.  Smith's  book  does. — Brit.  Med.  Jour*., 
of  which  it  is  a  symptom  ;  and  this  is  excellently  well    April  8,  1871. 
done  by  Dr.  Smith.    The  book  might  fairly  be  de- 1 


HENRY  C.  LEA'S  PUBLICATIONS — (Diseases  of  Women). 


(Free  of  postage  for  1875.) 


rTHE  OBSTETRICAL  JOURNAL. 

THE    OBSTETRICAL   JOURNAL   of  Great   Britain  and  Ireland; 

Including  MIDWIFERY,  and  the  DISEASES  OF  WOMEN  AND  INFANTS.  With  an  American 
Supplement,  edited  by  WILLIAM  F.  JENKS,  M.D.  A  monthly  of  about  80  octavo  pages, 
very  handsomely  printed.  Subscription,  Five  Dollars  per  annum.  Single  Numbers,  50 
cents  each. 

Commencing  with  April,  1873,  the  Obstetrical  Journal  consists  of  Original  Papers  by  Brit- 
ish and  Foreign  Contributors  ;  Transactions  of  the  Obstetrical  Societies  in  England  and  abroad  ; 
Reports  of  Hospital  Practice;  Reviews  and  Bibliographical  Notices;  Articles  and  Notes,  Edito- 
rial, Historical,  Forensic,  and  Miscellaneous;  Selections  from  Journals;  Correspondence,  Ac. 
Collecting  together  the  vast  amount  of  material  daily  accumulating  in  this  important  and  ra- 
pidly improving  department  of  medical  science,  the  value  of  the  information  which  it  pre- 
sents to  the  subscriber  may  be  estimated  from  the  character  of  the  gentlemen  who  have  already 
promised  their  support,  including  such  names  as  those  of  Drs.  ATTHILL,  ROBERT  BARNES,  HENRY 
BENNET,  THOMAS  CHAMBERS,  FLEETWOOD  CHURCHILL,  MATTHEWS  DUNCAN,  GRAILY  HEWITT, 
BRAXTON  HICKS,  ALFRED  MEADOWS,  W.  LEISHMAN,  ALEX.  SIMPSON,  TYLER  SMITH,  EDWARD  J. 
TILT,  SPENCER  WELLS,  Ac.  &c. ;  in  short,  the  representative  men  of  British  Obstetrics  and  Gynae- 
cology. 

In  order  to  render  the  OBSTETRICAL  JOURNAL  fully  adequate  to  the  wants  of  the  American 
profession,  each  number  contains  a  Supplement  devoted  to  the  advances  made  in  Obstetrics  and 
Gynaecology  on  this  side  of  the  Atlantic.  This  portion  of  the  Journal  is  under  the  editorial 
charge  of  Dr.  WILLIAM  F.  JENKS,  to  whom  editorial  communications,  exchanges,  books  for  re- 
view, &c.,  may  be  addressed,  to  the  care  of  the  publisher. 

***  Complete  sets  from  the  beginning  can  no  longer  be  furnished,  but  subscriptions  can  com- 
mence with  January,  1875,  or  with  Vol.  II.,  April,  1874. 


IJ^HOMAS  (T.GAILLARD),M.D., 

Professor  of  Obstetrics,  &c.,  in  the  College  of  Physicians  and  Surgeons,  N.  Y.,  Sec. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  WOMEN.   Fourth 

edition,  enlarged  and  thoroughly  revised.     In  one  large  and  handsome  octavo  volume  of 
800  pages,  with  191  illustrations.     Cloth,  $5  00;  leather,  $6  00.     (Now  Ready.) 
The  author  has  taken  advantage  of  the  opportunity  afforded  by  the  call  for  another  edition  of 
this  work  to  render  it  worthy  a  continuance  of  the  very  remarkable  favor  with  which  it  has  been 
received.     Every  portion  has  been  subjected  to  a  conscientious  revision,  and  no  labor  has  been 
spared  to  make  it  a  complete  treatise  on  the  most  advanced  condition  of  its  important  subject. 

A  few  notices  of  the  previous  editions  are  subjoined  : — 

No  general  practitioner  can  afford  to  be  without 
it. — St.  Loriis  Med.  and  Sury.  Journal,  May,  1872. 


United  States  by  storm  when  his  book  first  made  its 
appe^i-aoce  early  in  1S68.     Its  reception  was  simply 
enthusiastic,   notwithstanding  a  few  adverse   criti- 
cisms from  our  transatlantic  brethren,  the  first  large    Jt  and  any  similar  work  in  the  English  language  ; 
editio»  was  rapidly  exhausted,  and  in  six  months  a     naF  more,  as  a  text-boek  for  students  aud  as  a  guide 


Its  able  author  need  not  fear  comparisdto  between 


second  one  was  issued,  and  in  two  years  a  third  one 
was  announced  and  published,  and  we  are  now  pro- 
mised the  fourth.  The  popularity  of  this  work  was 
not  ephemeral,  and  its  success  was  unprecedented  in 
the  annals  of  American  medical  literature.  Six  years 
is  a  long  period  in  medical  scientific  research,  but 
Thomas's  work  on  "Diseases  of  Women"  is  still  the 
leading  native  production  of  the  United  States.  The 
order,  the  matter,  the  absence  of  theoretical  disputa- 
tiveness,  the  fairness  of  statement,  and  the  elegance 
of  diction,  preserved  throughout  the  entire  range  of 


the  book,  indicate  that  Professor  Thomas  did  not 
overestimate  his  powers  when  he  conceived  the  idea 
and  executed  the  work  of  producing  a  new  treatise 
upon  diseases  of  women. — PROP.  FALLEN,  in  Louis- 
ville Sfed.  Journal,  Sept.  1874. 

Briefly,  we  may  say  that  we  know  of  no  book 
which  so  completely  and  concisely  represents  the 
present  state  of  gynaecology;  none  so  full  of  well- 
digested  and  reliable  teaching  ;  none  which  bespeaks 
an  author  more  apt  in  research  and  abnniant  in  re- 
sources.— N.  T.  Med.  Record,  May  1,  1872. 

We  should  not  be  doing  our  duty  to  the  profession 
did  we  not  tell  those  who  are  unacquainted  with  th«  ,  . 

book,  how  much  it  is  valued  by  gynecologists,  and  8econd  edlt}on  makes  its  appearance  shows  that  the 
how  it  is  in  many  respects  one  of  the  best  text-books  '  general  judgment  of  the  Profession  has  largely  con- 
on  the  subject  we  possess  in  our  language.  We  have  ;  firmed  the  opinion  we  gave  at  that  time.-Ctwet»nai< 
no  hesitation  in  recommending  Dr.  Thomas's  work  as  i  Lancet,  Aug.  lsb». 

one  of  the  most  complete  of  its  kind  ever  published.  I  It  ig  go  short  a  time  Bince  we  gave  a  fun  revieir  of 
It  should  be  in  the  possession  of  every  practitioner  |  the  flrst  edition  of  this  boo^t  that  we  deem  it  only 
for  reference  and  for  study.— London  Lancet,  April  |  aecesgary  now  to  call  attention  to  the  second  appear- 
27.  1872.  i  ance  of  tne  WOrk.  its  success  has  been  remarkable, 

We  are  free  to  say  that  we  regard  Dr.  Thomas  the  !  and  we  can  only  congratulate  the  author  on  the 
best  American  authority  on  diseases  of  women. —  J  brilliant  reception  his  book  has  received. — N.  Y.  Mtd. 
Cincinnati  Lancet  and  Observer,  May,  1872.  Journal,  April,  1869. 


for  practitioners,  we  believe  it  is  unequalled.  If 
either  student  or  practitioner  can  get  but  one  book 
on  diseases  of  women, that  book  should  be  "Thomas." 
— Amer.  Jour.  Med.  Sciences,  April,  '872. 

To  students  we  unhesitatingly  recommend  it  as 
the  best  text-book  on  diseases  of  females  extant. — 
St  Louis  Med.  Reporter,  June,  1869. 

Of  all  the  army  of  books  that  nave  appeared  of  late 
years, on  the  diseases  of  the  uterus  and  its  appendages, 
we  know  of  none  that  is  so  clear,  comprehensive,  and 


practical  as  this  of  Dr.  Thomas',  or  one  that  we  should 
more  emphatically  recommend  to  the  young  practi- 
tioner, as  his  guide. — California  Med.  Gazette,  June, 
1869. 

It  would  be  superfluous  to  give  an  extended  review 
of  what  is  now  firmly  established  as  the  American 
text-book  of  Gynsecology. — JV.  Jf.  Med.  Gazette,  July 
17,  1869. 

This  is  a  new  and  revised  edition  of  a  work  which 
we  recently  noticed  at  some  length,  and  earnestly 
commended  to  the  favorable  attention  of  our  readers. 
The  fact  that,  in  the  short  space  of  one  year,  this 


HENRY  C.  LEA'S  PUBLICATIONS — (Diseases  of  Women). 


23 


TTODGE  (HUGH  L.),  M.D., 

*••*•  Emeritus  Professor  of  Obstetrics,  Ac.,  in  the  University  of  Pennsylvania. 

ON  DISEASES  PECULIAR  TO  WOMEN;  including  Displacements 

of  the  Uterus.     With  original  illustrations.     Second  edition,  revised  and  enlarged.     In 

one  beautifully  printed  octavo  volume  of  531  pages,  cloth,  $4  50. 

that  which  speaks  of  the  mechanical  treatment  of  dis- 
placements of  that  organ.  He  is  disposed,  as  a  non- 
believer  In  the  frequency  of  inflammations  of  the 
uterus,  to  take  strong  ground  against  many  of  the 


from  PROF.  W.  H.  BTFORD,  of  the  Rush  Medical 

College,  Chicago. 

The  book  bears  the  ynpress  of  a  master  hand,  and 
must,  as  its  predecessor,  prove  acceptable  to  the  pro- 


fession. In  diseases  of  women  Dr.  Hodge  has  estab- 
lished a  school  of  treatment  that  has  become  world- 
wide in  fame. 

Professor  Hodge's  work  Is  truly  an  original  one 
from  beginning  to  end,  consequently  no  one  can  pe- 
ruse its  pages  without  learning  something  new.  The 
book,  which  is  by  no  means  a  large  one,  is  divided  into 
two  grand  sections,  so  to  speak  :  first,  that  treating  of 
the  nervous  sympathies  of  the  uterus,  and,  secondly, 


highest  authorities  in  this  branch  of  medicine,  and 
the  arguments  which  he  offers  in  support  of  his  posi- 
tion are,  to  say  the  least,  well  put.  Numerous  wood- 
cuts adorn  this  portion  of  the  work,  and  add  incalcu- 
lably to  the  proper  appreciation  of  the  variously 
shaped  instruments  referred  to  by  our  author.  As  a 
contribution  to  the  study  of  women's  diseases,  it  is  of 
great  value,  and  is  abundantly  able  to  stand  on  its 
own  merits.— N.  Y.  Medical  Record,  Sept.  15,  1868. 


WEST  (CHARLES),  M.D. 

LECTURES  ON  THE  DISEASES  OF  WOMEN.    Third  American, 

from  the  Third  London  edition.     In  one  neat  octavo  volume  of  about  550  pages,  cloth, 

$3  75  ;  leather,  $4  75. 

As  a  writer,  Dr.  West  stands,  in  our  opinion,  se- 1  seeking  truth,  and  one  that  will  convfcce  the  student 
cond  only  to  Watson,  the  "Macaulay  of  Medicine;'     that  he  has  committed  himself  to  a  candid,  safe,  and 
he  possesses  that  happy  faculty  of  clothing  instrnc-    valuable  guide. — N.  A.  Ifed.-Chirurg  Review. 
tion  in   easy  garments ;    combining   pleasure   with 

profit,  he  leads  his  pupils,  in  spite  of  the  ancient  pro-  :  We  ha™  to  8aT  of  u»  bnefly  and  *««M««7i  that  II 
verb,  along  a  royal  road  to  learning.  His  work  is  one  ls  the  best  work  on  tbe  subject  in  any  language,  and 
which  will  not  satisfy  the  extreme  on  either  side,  but  that  u  stamps  Dr.  West  as  the  facile  prmceps  of 
It  is  one  that  will  please  the  great  majority  who  are  British  obstetric  authors.— Edinburgh  Med.  Journal. 

1DARNES  (ROBERT),  M.  D.,  F.  R.  C.  P., 

•*-*  Obstetric  Physician  to  St.  Thomas's  Hospital,  Ac. 

A  CLINICAL  EXPOSITION  OP  THE  MEDICAL  AND  SURGI- 
CAL DISEASES  OF  WOMEN.  In  one  handsome  octavo  volume  of  about  800  pages,  with 
169  illustrations.  Cloth,  $5  00  ;  leather,  $6  00.  (Just  Issued.) 

The  very  complete  scope  of  this  volume  and  the  manner  in  which  it  has  been  filled  out,  may 
be  seen  by  the  subjoined  Summary  of  Contents. 

INTRODUCTION.  CHAPTER  I.  Ovaries  ;  Corpus  Luteura.  II.  Fallopian  Tubes.  III.  Shape  of 
Uterine  Cavity.  IV.  Structure  of  Uterus.  V.  The  Vngina.  VI.  Examinations  and  Diagnosis. 
VII.  Significance  of  Leucorrhoea.  VIII.  Discharges  of  Air.  IX.  Watery  Discharges.  X.  Puru- 
lent Discharges.  XI.  Hemorrhagic  Discharges.  XII.  Significance  of  Pain.  XIII.  Significance 
of  Dyspareunia.  XIV.  Significance  of  Sterility.  XV.  Instrumental  Diagnosis  and  Treatment. 
XVI.  Diagnosis  by  the  Touch,  the  Sound,  the  Speculum.  XVII.  Menstruation  and  its  Disor- 
ders. XVIII.  Amenorrhoea.  XIX.  Amenorrhoea  (continued).  XX.  Dysmenorrhoea.  XXI. 
Ovarian  Dysmenorrhoea,  &c.  XXII.  Inflammatory  Dysmenorrhoea.  XXIII.  Irregulnrities  of 
Change  of  Life.  XXIV.  Relations  between  Menstruation  and  Diseases.  XXV.  Disorders  of  Old 
Age.  XXVI.  Ovary,  Absence  and  Hernia  of.  XXVII.  Ovary,  Hemorrhage,  Ac.,  of.  XXVIII. 
Ovary,  Tubercle,  Cancer,  &c.,  of.  XXIX.  Ovarian  Cystic  Tumors.  XXX.  Dermoid  Cysts  of 
Ovary.  XXXI.  Ovarian  Tumors,  Prognosis  of.  XXXII.  Dingnosis  of  Ovarian  Tumors.  XXXIII. 
Ovarian  Cysts,  Treatment  of.  XXXIV.  Fallopian  Tubes,  Diseases  of.  XXXV.  Broad  Liga- 
ments, Diseases  of.  XXXVI.  Extra-uterine  Gestation.  XXXVII.  Special  Pathology  of  Ute 
rus.  XXXVIII  General  Uterine  Pathology.  XXXIX.  Alterations  of  Blood  Supply.  XL. 
Metritis,  Endometritis,  Ac,  XLI.  Pelvic  Cellulitis  and  Peritonitis,  Ac.  XLII.  Haematocele,  <ko 
XLIII.  Displacements  of  Uterus.  XLIV.  Displacements  (continued).  XLV.  Retroversion  and 
Retroflexion.  XLVI.  Inversion.  XLVII.  Uterine  Tumors.  XLVIII.  Polypus  Uteri.  XLIX. 
Polypus  Uteri  (continued).  L.  Cancer.  LI.  Diseases  of  Vagina.  LII.  Diseases  of  the  Vulva. 


Embodyingthelongexperlenoe  and  personal  obser- 
vation of  one  of  the  greatest  of  living  teachers  in  dis- 
eases of  women,  it  seems  pervaded  by  the  presence 
of  the  author,  who  speaks  directly  to  the  reader,  and 
speaks,  too,  as  one  having  authority.  And  yet,  not- 
withstanding this  distinct  personality,  there  is  noth- 
ing narrow  as  to  time,  place,  or  individuals,  in  the 
views  presented,  and  in  the  instructions  given;  Dr. 
Barnes  has  been  an  attentive  student,  not  only  of  Eu- 
ropean, but  also  of  American  literature,  pertaining  to 
diseases  of  females,  and  enriched  his  own  experience 
by  treasures  theiice  gathered  ;  he  seems  as  familiar, 
for  example,  with  the  writings  of  Sims,  Emmet,  Tho- 


mas, and  Peaslee,  as  if  these  eminent  men  were  his 
countrymen  and  colleagues,  and  gives  them  a  credit 
which  must  be  gratifying  to  every  American  physi- 
cian.—vim.  Journ.  Med.  Set.,  April,  1874. 

Throughout  the  whole  book  it  is  impossible  not  to 
feel  that  theauthorhas spontaneously,  conscientious- 
ly, and  fearlessly  performed  his  task.  He  goes  direct 
to  the  point,  and  does  not  loiter  on  the  way  to  gossip 
or  quarrel  with  other  authors.  Dr.  Barnes's  hook 
will  be  eagerly  read  all  over  the  world,  and  will 
everywhere  be  admired  for  its  comprehensiveness, 
honesty  of  purpose,  and  ability.  —  The  Obstet.  Journ. 
of  Great  Britain  and  Ireland,  March,  1874. 


CHURCHILL  ON  THE  PUERPERAL  FEVER  AND 
OTHER  DISEASES  PECULIAR  TO  WOMEN.  1  vol. 
8vo.,  pp.  450,  cloth.  $2  50. 

MEIGS  ON  WOMAN:  HER  DISEASES  AND  THEIR 
REMEDIES.  A  Series  of  Lectures  to  his  Class. 
Fourth  and  Improved  Edition.  1  vol.  8vo.,  over 
700  pages,  cloth,  $5  00  ;  leather,  *6  00. 

MEIGS  ON  THE  NATURE,  SIGNS,  AND  TREAT- 
MENT OF  CHILDBED  FEVER.  1  vol.  8vo..  pp. 
SSi,  cloth.  02  00. 


ASHWELL'S  PRACTICAL  TREATISE  ON  THE  DIS- 
EASES PECULIAR  TO  WOMEN.  Third  American, 
from  the  Third  and  revised  London  edition.  1  vol. 
8vo.,  pp.  528,  cloth.  $3  50. 

DEWEES'S  TREATISE  ON  THE  DISEASES  OF  FE- 
MALES. With  illustrations.  Eleventh  Edition, 
with  the  Author's  last  improvements  and  correc- 
tions. In  one  octavo  volume  of  636  pages,  with 
plates,  cloth.  $3  00. 


HENRY  C.  LEA'S  PUBLICATIONS — (Midwifery'). 


TTODGE  (HUGH  L.),  M.D., 

•*•-*•  Emeritus  Professor  of  Midwifery,  Ac.,  in  the  University  of  Pennsylvania,  Ac. 

THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRICS.  Illus- 
trated with  large  lithographic  plates  containing  one  hundred  and  fifty-nine  figures  from 
original  photographs,  and  with  numerous  wood-cuts.  In  one  large  and  beautifully  printed 
quarto  volume  of  550  double-columned  pages,  strongly  bound  in  cloth,  $14. 


The  work  of  Dr.  Hodge  is  something  more  than  a 
•imple  presentation  of  his  particular  views  in  the  de- 
partment of  Obstetrics ;  it  is  something  more  than  an 
ordinary  treatise  on  midwifery ;  it  is,  in  fact,  a  cyclo- 
paedia of  midwifery.  He  has  aimed  to  embody  in  a 
single  volume  the  whole  science  and  art  of  Obstetrics. 
An  elaborate  text  is  combined  with  accurate  and  va- 
ried pictorial  illustrations,  so  that  no  fact  or  principle 
Is  left  unstated  or  unexplained. — Am.  Med.  Times, 
Sept.  3,  1864. 

We  should  like  to  analyze  the  remainder  of  this 
excellent  work,  but  already  has  this  review  extended 
beyond  our  limited  space.  We  cannot  conclude  this 
notice  without  referring  to  the  excellent  finish  of  the 
work.  In  typography  it  is  not  to  be  excelled ;  the 
paper  is  superior  to  what  is  usually  afforded  by  our 
American  cousins,  quite  equal  to  the  best  of  English 
books.  The  engravings  and  lithographs  are  most 


We  have  examined  Professor  Hodge's  work  with 
?reat  satisfaction ;  every  topic  is  elaborated  most 
Fully.  The  views  of  the  author  are  comprehensive, 
and  concisely  stated.  The  rules  of  practice  are  judi- 
cious, and  will  enable  the  practitioner  to  meet  every 
emergency  of  obstetric  complication  with  confidence. 
— Chicago  Med.  Journal,  Aug.  1864. 

More  time  than  we  have  had  at  our  disposal  since 
we  received  the  great  work  of  Dr.  Hodge  is  necessary 
to  do  it  justice.  It  is  undoubtedly  by  far  the  most 
original,  complete,  and  carefully  composed  treatise 
on  the  principles  and  practice  of  Obstetrics  which  hai 
ever  been  issued  from  the  American  press. — Pacific 
Med.  and  Surg.  Journal,  July,  1864. 

We  have  read  Dr.  Hodge's  book  with  great  plea- 
sure, and  have  much  satisfaction  in  expressing  our 
commendation  of  it  as  a  whole.  It  is  certainly  highly 


beautifully  executed.    The  work  recommends  itself  (instructive,  and  in  the  main,  we  believe,  correct  "The 
for  its  originality,  and  is  in  every  way  a  most  yalu-  great  attention  which 


able  addition  to  those  on  the  subject  of  obstetrics. — 
Canada  Med.  Journal,  Oct.  1864. 

It  is  very  large,  profusely  and  elegantly  illustrated, 
and  is  fitted  to  take  its  place  near  the  works  of  great 
obstetricians.  Of  the  American  works  on  the  subject 


ch  the  author  has  devoted  to  the 
mechanism  of  parturition,  taken  along  with  the  con- 
clusions at  which  he  has  arrived,  point,  we  think, 
conclusively  to  the  fact  that,  in  Britain  at  least,  the 
doctrines  of  Naegele  have  been  too  blindly  received. 
— Glasgow  Med.  Journal,  Oct.  1864. 
It  is  decidedly  the  best. — Edinb.  Med.  Jour.,  Dec.  "'64. ' 

#**  Specimens  of  the  plates  and  letter-press  will  be  forwarded  to  any  address,  free  by  mail, 
en  receipt  of  six  cents  in  postage  stamps. 

BANNER  (THOMAS  H.),  M.D. 
ON  THE  SIGNS  AND  DISEASES  OF  PREGNANCY.     First  American 

from  the  Second  and  Enlarged  English  Edition.     With  four  colored  plates  and  illustrations 
on  wood.     In  one  handsome  octavo  volume  of  about  500  pages,  cloth,  $4  25. 


The  very  thorough  revisiom  the  work  has  undergone 
has  added  greatly  toils  practical  value,  and  increased 
materially  its  efficiency  as  a  guide  to  the  student  and 
to  the  young  practitioner.—  Am.  Journ.  Med.  Set., 
April,  1868. 

With  the  immense  variety  of  subjects  treated  of 
and  the  ground  which  they  are  made  to  cover,  the  im- 
possibility of  giving  an  extended  review  of  this  truly 
remarkable  work  must  be  apparent.  We  have  not  a 
single  fault  to  find  with  it,  and  most  heartily  com- 
mend it  to  the  careful  study  of  every  physician  who 
would  not  only  always  be  sure  of  his  diagnosis  of 


pregnancy,  but  always  ready  to  treat  all  the  nume- 
rous ailments  that  are,  unfortunately  for  the  civilized 
women  of  to-day,  so  commonly  associated  with  the 
function.— N.  ¥.  Med.  Record,  March  16,  1S68. 

We  recommend  obstetrical  students,  young  and 
old,  to  have  this  volume  in  their  collections.  It  con- 
tains not  onlj  a  fair  statement  of  the  signs,  symptoms, 
and  diseases  of  pregnancy,  but  comprises  in  addition 
much  interesting  relative  matter  that  is  not  to  be 
found  in  any  other  work  that  we  can  name. — Edin- 
burgh Med  Journal,  Jan.  1868. 


tt WAYNE  (JOSEPH  GRIFFITHS),  M.  D., 

***  Physician-Accoucheur  to  the  British  General  Hospital,  &c. 

OBSTETRIC  APHORISMS  FOR  THE  USE  OF  STUDENTS  COM- 

MENCING  MIDWIFERY  PRACTICE.  Second  American,  from  the  Fifth  and  Revised 
London  Edition,  with  Additions  by  E.  R.  HUTCHINS,  M.  D.  With  Illustrations.  In  one 
neat  12mo.  volume.  Cloth,  $1  25.  (Lately  Issued.) 

*$*  See  p.  3  of  this  Catalogue  for  the  terms  on  which  this  work  is  offered  as  a  premium  to 
subscribers  to  the  "AMERICAN  JOURNAL  OP  THE  MEDICAL  SCIENCES." 

It  is  really  a  capital  little  compendium  of  the  sab- i  answers  the  purpose.  It  is  not  only  valuable  for 
Ject,  and  we  recommend  young  practitioners  to  buy  it  young  beginners,  but  no  one  who  is  not  a  proficient 
and  carry  it  with  them  when  called  to  attend  cases  of  I  in  the  art  of  obstetrics  should  be  without  it,  because 
labor.  They  can  while  away  the  otherwise  tedious  |  it  condenses  all  that  is  necessary  to  know  for  ordi- 
hours  of  waiting,  and  thoroughly  fix  in  their  memo-  j  nary  midwifery  practice.  We  commend  the  book 


ries  the  most  important  practical  suggestions  it  con- 
tains. The  American  editor  has  materially  added  by 
his  notes  and  the  concluding  chapters  to  the  com- 
pleteness and  general  value  of  the  book. — Chicago 
Med.  Journal,  Feb.  1870. 

The  manual  before  us  containsin  exceedingly  small 


most  favorably. — St.  Louis  Med.  and  Surg.  Journal, 
Sept.  10,  1870. 

A  studied  perusal  of  this  little  book  has  satisfied 
us  of  its  eminently  practical  value.  The  object  of  the 
work,  the  author  says,  in  his  preface,  is  to  give  the 
student  a  few  brief  and  practical  directions  respect- 


compass-small  enough  to  carry  in  the  pocket-about  |  {      the  management  of  o£diaary  Ca8e8  of  labor  ;  an 
£L™!i™_?S  ^V;  \™*: C°nden8ed >n  ,°_a  ,nu  ^eU_°/i  also  to  point  out  to  him  in  extraordinary  cases  whe 


„,,     ...  , 

Aphorisms.    The  illustrations  are  well  selected  and 

serve  as  excellent  reminders  of  the  conduct  of  labor — 

regular  and  difficult. — Cincinnati  Lancet,  April,  '70. 

This  is  a  mostadmirable  little  work,  and  completely 


and  how  he  may  act  upon  his  own  responsibility,  and 
when  he  ought  to  send  for  assistance. — Jf.  Y.  Medical 
Journal,  May,  1870. 


TUINCKEL  (F.), 

Professor  and  Director  of  the  Gynaecological  Clinic  in  the  University  of  Rostock. 

A  COMPLETE  TREATISE  ON  THE  PATHOLOGY  AND  TREAT- 

MENT  OF  CHILDBED,  for  Students  and  Practitioners.  Translated,  with  the  consent  of 
the  author,  from  the  Second  German  Edition,  by  JAMES  READ  CHADWICK,  M.D.  In  one 
octavo  volume.  (Preparing.) 


HENRY  C.  LEA'S  PUBLICATIONS — (Midwifery). 


25 


' '  EISHMAN  ( WILLIAM),  M.D., 

Regius  Professor  of  Midwifery  in  the  University  of  Glasgow,  Ac. 

A  SYSTEM  OF  MIDWIFERY,  INCLUDING  THE  DISEASES  OF 

PREGNANCY  AND  THE  PUERPERAL  STATE.  In  one  large  and  very  handsome  oc- 
tavo volume  of  over  700  pages,  with  one  hundred  and  eighty-two  illustrations.  Cloth, 
$5  00  ;  leather,  $6  00.  (Lately  Published.) 


This  is  one  of  a  most  complete  aud  exhaustive  cha- 
racter. We  have  gone  carefully  through  it,  and  there 
is  no  subject  in  Obstetrics  which  has  not  been  con- 
sidered well  and  fully.  The  result  is  a  work,  not 
only  admirable  as  a  text-book,  but  valuable  as  a  work 
of  reference  to  the  practitioner  in  the  various  emer- 
gencies of  obstetric  practice.  Take  it  all  in  all,  we 
have  no  hesitation  in  say  ing  that  it  is  incur  judgment 
the  best  Euglish  work  ou  the  subject. — London Lan- 
cet, Aug.  23,  1873. 

The  work  of  Leishman  gives  an  excellent  view  of 
modern  midwifery,  and  evinces  its  author's  extensive 
acquaintance  with  British  and  foreign  literature  ;  and 
not  only  acquaintance  with  it,  but  wholesome  diges- 
tion and  sound  judgment  of  it.  He  has,  withal,  a 
manly,  free  style,  and  can  state  a  difficult  and  compli- 
'  cated  matter  with  remarkable  clearness  and  brevity. 
—Edin.  Med.  Journ.,  Sept.  1873. 

The  author  has  succeeded  in  presenting  to  the  pro- 
fession an  admirable  treatise,  especially  in  its  practi- 
cal aspects  ;  one  which  is,  in  general,  clearly  written, 
and  sound  in  doctrine,  and  one  which  cannot  fail  to 
add  to  his  already  high  reputation.  In  concluding 
our  examination  of  this  work,  we  cannot  avoid  again 
saying  that  Dr.  Leishman  has  fully  accomplished 
that  difficult  task  of  presenting  a  good  text-book  upon 
obstetrics.  We  know  none  better  for  the  use  of  the  stu- 
dent or  junior  practitioner. — Am.  Practitioner,  Mar. 
1874. 

It  proposes  to  offer  to  practitioners  and  students 


"A  Complete  System  of  the  Midwifery  of  the  Present 
Day,"  and  well  redeems  the  promise.  In  all  that 
relates  to  the  subject  of  labor,  the  teaching  is  admi- 
rably clear,  concise,  and  practical,  representing  not 
alone  British  practice,  but  the  contributions  of  Con- 
tinental and  Ajnerican  schools. — JV.  Y.  3fed.  Record, 
March  2,  1874. 

The  work  of  Dr.  Leishman  is,  in  many  respects, 
not  only  the  best  treatise  on  midwifery  that  we  have 
seen,  but  one  of  the  best  treatises  on  any  medical  sub- 
ject that  has  been  published  of  late  years. — Lund. 
Practitioner,  Feb.  1874. 

It  was  written  to  supply  a  desideratum,  and  we  will 
be  much  surprised  if  it  does  not  fulfil  the  purpose  of 
its  author.  Taking  it  as  a  whole,  we  know  of  no 
work  on  obstetrics  by  an  English  author  in  which  th« 
student  and  the  practitioner  will  find  the  information 
so  clear  and  so  completely  abreast  of  the  present  state 
of  our  knowledge  on  the  subject.—  Glasgow  Med. 
Journ.,  Aug.  1873. 

Dr.  Leishman's  System  of  Midwifery,  which  has 
only  just  been  published,  will  go  far  to  supply  the 
want  which  has  so  long  been  felt,  of  a  really  good 
modern  English  text-book.  Although  large,  as  is  in- 
evitable in  a  work  on  so  extensive  a  subject,  it  is  so 
well  and  clearly  written,  that  it  is  never  wearisome 
to  read.  Dr.  Leishman's  work  may  be  confidently 
recommended  as  an  admirable  text-book,  and  is  sure 
to  be  largely  used. — Land.  Med.  Record,  Sept.  1S73. 


ftAMSBOTHAM  (FRANCIS  H.),  M.D. 

THE  PRINCIPLES   AND    PRACTICE   OF   OBSTETRIC  MEDI- 

CINE  AND  SURGERY,  in  reference  to  the  Process  of  Parturition.  A  new  and  enlarged 
edition,  thoroughly  revised  by  the  author.  With  additions  by  W.  V.  KEATING,  M.  D., 
Professor  of  Obstetrics,  &c.,  in  the  Jefferson  Medical  College,  Philadelphia.  In  one  large 
and  handsome  imperial  octavo  volume  of  650  pages,  strongly  bound  in  leather,  with  raised 
bands  ;  with  sixty-four  beautiful  plates,  and  numerous  wood-cuts  in  the  text,  containing  in 
all  nearly  200  large  and  beautiful  figures.  $7  00. 


We  will  only  add  that  the  student  will  learn  from 
it  all  he  need  to  know,  and  the  practitioner  will  find 
it,  as  a  book  of  reference,  surpassed  by  none  other. — 
Stethoscope. 

The  character  and  merits  of  Dr.  Ramsbotham's 
work  are  so  well  known  and  thoroughly  established, 
that  comment  is  unnecessary  and  praise  superfluous. 
The  illustrations,  which  are  numerous  and  accurate, 
are  executed  in  the  highest  style  of  art.  We  cannot 
too  highly  recommend  the  work  to  our  readers. — Si. 
Louis  Med.  and  Surg.  Journal. 


To  the  physician's  library  ills  Indispensable,  while 
to  the  student,  as  a  text-book,  from  which  to  extract 
the  material  for  laying  the  foundation  of  an  education 
on  obstetrical  science,  it  has  no  superior. — Ohio  Med. 
and  Surg.  Journal. 

When  we  call  to  mind  the  toil  we  underwent  in 
acquiring  a  knowledge  of  this  subject,  we  cannot  but 
i  envy  the  student  of  the  present  day  the  aid  which 
j  this  work  will  afford  him. — Am.  Jour,  of  the  Med. 
Sciences. 


fJHURCHILL  (FLEETWOOD),  M.D.,  M.R.I. A. 

ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY.    A  new 

American  from  the  fourth  revised  and  enlarged  London  edition.  With  notes  and  additions 
by  D.  FRANCIS  CONDIE,  M.  D.,  author  of  a  "Practical  Treatise  on  the  Diseases  of  Chil- 
dren,'' <fcc.  With  one  hundred  and  ninety-four  illustrations.  In  one  very  handsome  octavo 
volume  of  nearly  700  large  pages.  Cloth,  $4  00;  leather,  $5  00. 

qnainted  can  compare  favorably  with  this,   in  re" 


These  additions  render  the  work  still  more  com- 
plete and  acceptable  than  ever ;  and  we  can  com- 
mend it  to  the  profession  with  great  cordiality  and 
pleasure. — Giminnati  Lancet. 

Few  work?  on  this  branch  of  medical  science  are 
aqnal  to  it,  certainly  none  excel  it,  whether  in  regard 
to  theory  or  practice — Brit.  Am.  Journal. 

No  trea'tise  on  obstetrics  with  which  we  are  ac- 


spect to  theamountof  material  which  has  been  gath- 
ered from  every  source. — Boston  Mtd.  and  Surg. 
Journal. 

There  is  no  better  text-book  for  students,  or  work 
of  reference  and  study  for  the  practising  physician 
than  this.  It  should  adorn  and  enrich  every  medical 
library. — Chicago  Med.  Journal. 


MONTGOMERY'S  EXPOSITION  OF  THE  SIGNS 
AND  SYMPTOMS  OF  PREGNANCY.  With  two 
exquisite  colored  plates,  and  numerous  wood-cuts. 
In  1vol.  8 vo.,  of  nearly.  600  Dp.,  cloth.  $3  75. 


aiGBY'S  SYSTEM  OF  MIDWIFERY.  With  Notes 
and  Additional  Illustrations.  Second  American 
edition.  One  volume  octavo,  cloth,  422  pages. 
$260. 


26 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


(>EOSS  (SAMUEL  />.),  M.D., 

^*  Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia. 

A  SYSTEM  OF  SURGERY:   Pathological,  Diagnostic,  Therapeutic, 

and  Operative.     Illustrated  by  upwards  of  Fourteen  Hundred  Engravings.     Fifth  edition, 
carefully  revised,  and  improved.    In  two  large  and  beautifully  printed  imperial  octavo  vol- 
umes of  about  2300  pages,  strongly  bound  in  leather,  with  raised  bands,  $15.    (Just  Issued.) 
The  continued  favor,  shown  by  the  exhaustion  of  successive  large  editions  of  this  great  work, 
proves  that  it  has  successfully  supplied  a  want  felt  by  American  practitioners  and  students.    In  the 
present  revision  no  pains  have  been  spared  by  the  author  to  bring  it  in  every  respect  fully  up  to 
the  day.     To  effect  this  a  large  part  of  the  work  has  been  rewritten,  and  the  whole  enlarged  by 
nearly  one-fourth,  notwithstanding  which  the  price  has  been  kept  at  its  former  very  moderate 
rate.     By  the  use  of  a  close,  though  very  legible  type,  an  unusually  large  amount  of  matter  is 
condensed  in  its  pages,  the  two  volumes  containing  as  much  as  four  or  five  ordinary  octavos. 
This,  combined  with  the  most  careful  mechanical  execution,  and  its  very  durable  binding,  renders 
it  one  of  the  cheapest  works  accessible  to  the  profession.    Every  subject  properly  belonging  to  the 
domain  of  surgery  is  treated  in  detail,  so  that  the  student  who  possesses  this  work  may  be  said  to 
have  in  it  a  surgical  library.     A  few  notices  of  the  previous  edition  are  subjoined  : — 


It  must  long  remain  the  most  comprehensive  work 
on  this  important  part  of  medicine. — Boston  Medical 
and  Surgical  Journal,  March  23,  1865. 

We  have  compared  it  with  most  of  onr  standard 
works,  such  as  those  of  Erichsen,  Miller,  Fergusson, 
Byrne,  and  others,  and  we  mast,  in  justice  to  oar 
author,  award  it  the  pre-eminence.  As  a  work,  com- 
plete in  almost  every  detail,  no  matter  how  minute 
or  trifling,  and  embracing  every  subject  known  in 
the  principles  and  practice  of  surgery,  we  believe  it 
stands  without  a  rival.  Dr.  Gross,  in  his  preface,  re- 
marks "my  aim  has  been  to  embrace  the  whole  do- 
main of  surgery,  and  to  allot  to  every  subject  its 
legitimate  claim  to  notice;"  and,  we  assure  our 
readers,  he  has  kept  his  word.  It  is  a  work  which 
we  can  most  confidently  recommend  to  our  brethren, 
for  its  utility  is'becoming  the  more  evident  the  longer 
It  is  upon  the  shelves  of  our  library. — Canada  Med. 
Journal,  September,  1865. 

The  first  two  editions  of  Professor  Gross'  System  of 
Sargery  are  so  wall  known  to  the  profession,  and  so 
highly  prized,  that  it  would  be  idle  for  us  to  speak  in 
praise  of  this  work. —  Chicago  Medical  Journal, 
September,  1865. 

We  gladly  indorse  the  favorable  recommendation 
of  the  work,  both  as  regards  matter  and  style,  which 
we  made  when  noticing  its  first  appearance. — British 
and  Foreign  Medico-Chirurgical  Review,  Oct.  1865. 

The  most  complete  work  that  has  yet  issued  from 
the  press  on  the  science  and  practice  of  surgery. — 
London  Lancet. 

This  system  of  surgery  Is,  we  predict,  destined  to 
take  a  commanding  position  in  our  surgical  litera- 
ture, and  be  the  crowning  glory  of  the  author's  well 
earned  fame.  As  an  authority  on  general  surgical 
subjects,  this  work  is  long  to  occupy  a  pre-eminent 
place,  not  only  at  home,  but  abroad.  We  have  no 

B 


hesitation  in  pronouncing  it  without  a  rival  in  our 
language,  and  equal  to  the  best  systems  of  surgery  in 
any  language. — Ar.  ¥.  Med.  Journal. 

Not  only  by  far  the  best  text-book  on  the  subject, ' 
as  a  whole,  within  the  reach  of  American  students, 
bat  one  which  will  be  much  more  than  ever  likely 
to  be  resorted  to  and  regarded  as  a  high  authority 
abroad. — Am.  Journal  Med.  Sciences,  Jan.  1665. 

The  work  contains  everything,  minor  and  major, 
operative  and  diagnostic,  including  mensuration  and 
examination,  venereal  diseases,  and  uterine  manipu- 
lations and  operations.  It  is  a  complete  Thesaurus 
of  modern  surgery,  where  the  student  and  practi- 
tioner shall  not  seek  in  vain  for  what  they  desire.— 
San  Francisco  Med.  Press,  Jan.  1865. 

Open  it  where  we  may,  we  find  sound  practical  in- 
formation conveyed  in  plain  language.  This  book  ii 
no  mere  provincial  or  even  national  system  of  sur- 
gery, but  a  work  which,  while  very  largely  indebted 
to  the  past,  has  a  strong  claim  on  the  gratitude  of  the 
future  of  surgical  science. — Edinburgh  Med.  journal, 
Jan.  1865. 

A  glance  at  the  work  is  sufficient  to  show  that  the 
author  and  publisher  have  spared  no  labor  in  making 
it  the  most  complete  "System  of  Sargery"  ever  pub- 
lished in  any  country. — St.  Louis  Med.  and  Surg. 
Journal,  April,  1865. 

A  system  of  surgery  which  we  think  unrivalled  in 
our  language,  and  which  will  indelibly  associate  his 
name  with  surgical  science.  And  what,  in  onr  opin- 
ion, enhances  the  value  of  the  work  is  that,  while  the 
practising  surgeon  will  find  all  that  he  requires  in  it, 
it  is  at  the  same  time  one  of  the  most  valuable  trea- 
tises which  can  be  put  into  the  hands  of  the  student 
seeking  to  know  the  principles  and  practice  of  thi* 
branch  of  the  profession  which  he  designs  subse- 
quently to  follow. — The  Brit.  Am.Journ.,  Montreal. 


T  THE  SAME  AUTHOR. 


A  PRACTICAL    TREATISE    ON    FOREIGN    BODIES   IN   THE 

AIR-PASSAGES.     In  1  vol.  8vo.,  with  illustrations,  pp.  468,  cloth,  $2  75. 


BKEY'S   OPERATIVE  SURGERY.     In  1   vol.   Svo.    GIBSON'S  INSTITUTES  AND  PRACTICE  OF  SUR- 


cloth,  of  over  660  pages ;  with  about  100  wood-cuts. 
$325. 

COOPER'S  LECTURES  ON  THE  PRINCIPLES  AND 
PKACTICB  OF  SURGERY.  In  1  vol.  Svo.  cloth,  750  p.  $2. 


UERY.  Eighth  edition,  improved  and  altered.  With 
thirty-four  plates.  In  two  handsome  octavo  vol- 
umes, about  1000  pp., leather, raised  bandt.  $6  50. 


M 


1LLER  (JAMES), 

Late  Professor  of  Surgery  in  the  University  of  Edinburgh,  Ac. 

PRINCIPLES  OF  SURGERY.     Fourth  American,  from  the  third  and 

revised  Edinburgh  edition.     In  one  large  and  very  beautiful  volume  of  700  pages,  with 
two  hundred  and  forty  illustrations  on  wood,  cloth,  $3  75. 


B 


Y  THE  SAME  AUTHOR.  

THE   PRACTICE   OF   SURGERY.    Fourth  American,  from  the  last 

Edinburgh  edition.  Revised  by  the  American  editor.  Illustrated  by  three  hundred  and 
sixty-four  engravings  on  wood.  In  one  large  octavo  volume  of  nearly  700  pages,  cloth, 
$3  75.  

ARGENT  (F.  W.),  M.D. 

OJN   BANDAGING  AND    OTHER   OPERATIONS   OF  MINOR 

SURGERY,  New  edition,  with  an  additional  chapter  on  Military  Surgery.  One  handsome 
royal  12mo.  volume,  of  nearly  400  pages,  with  184  wood-cuts.  Cloth,  $1  76. 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


ASHHURST  (JOHN,  Jr.),  M.D., 

Surgeon  to  the  Episcopal  Hospital,  Philadelphia. 

THE   PRINCIPLES   AND   PRACTICE  OF   SURGERY.    In  one 

very  large  and  handsome  octavo  volume  of  about  1000  pages,  with  nearly  550  illustrations, 
cloth,  $6  50;  leather,  raised  bands,  $7  50.      (Lately  Published.) 

The  object  of  the  author  has  been  to  present,  within  as  condensed  a  compass  as  possible,  a 
complete  treatise  on  Surgery  in  all  its  branches,  suitable  both  as  a  text-book  for  the  student  and 
a  work  of  reference  for  the  practitioner.  So  much  has  of  late  years  been  done  for  the  advance- 
ment of  Surgical  Art  and  Science,  that  there  seemed  to  be  a  want  of  a  work  which  should  present 
the  latest  aspects  of  every  subject,  and  which,  by  its  American  character,  should  render  accessible 
to  the  profession  at  large  the  experience  of  the  practitioners  of  both  hemispheres.  This  has  been 
the  aim  of  the  author,  and  it  is  hoped  that  the  volume  will  be  found  to  fulfil  its  purpose  satisfac- 
torily. The  plan  and  general  outline  of  the  work  will  be  seen  by  the  annexed 

CONDENSED  SUMMARY  OF  CONTENTS. 

CHAPTER  I.  Inflammation.  II.  Treatment  of  Inflammation.  III.  Operations  in  general : 
Anaesthetics.  IV.  Minor  Surgery.  V.  Amputations.  VI.  Special  Amputations.  VII.  Effects 
of  Injuries  in  General  :  Wounds.  VIII.  Gunshot  Wounds.  IX.  Injuries  of  Bloodvessels.  X. 
Injuries  of  Nerves,  Muscles  and  Tendons,  Lymphatics,  Bursse,  Bones,  and  Joints.  XI.  Fractures. 
XII.  Special  Fractures.  XIII.  Dislocations.  XIV.  Effects  of  Heat  and  Cold.  XV.  Injuries 
of  the  Head.  XVI.  Injuries  of  the  Back.  XVII.  Injuries  of  the  Face  and  Neck.  XVIII. 
Injuries  of  the  Chest.  XIX.  Injuries  of  the  Abdomen  and  Pelvis.  XX.  Diseases  resulting  from 
Inflammation.  XXI.  Erysipelas.  XXII.  Pyaemia.  XXIII.  Diathetic  Diseases  :  Struma  (in- 
cluding Tubercle  and  Scrofula);  Rickets.  XXIV.  Venereal  Diseases  ;  Gonorrhoea  and  Chancroid. 
XXV.  Venereal  Diseases  continued  :  Syphilis.  XXVI.  Tumors.  XXVII.  Surgical  Diseases  of 
Skin,  Areolar  Tissue,  Lymphatics,  Muscles,  Tendons,  and  Bursae.  XXVIII.  Surgical  Disease 
of  Nervous  System  (including  Tetanus).  XXIX.  Surgical  Diseases  of  Vascular  System  (includ- 
ing Aneurism).  XXX.  Diseases  of  Bone.  XXXI.  Diseases  of  Joints.  XXXII.  Excisions. 
XXXIII.  Orthopaedic  Surgery.  XXXIV.  Diseases  of  Head  and  Spine.  XXXV.  Diseases  of  the 
Eye.  XXXVI.  Diseases  of  the  Ear.  XXXVII.  Diseases  of  the  Face  and  Neck.  XXXVIII. 
Diseases  of  the  Mouth,  Jaws,  and  Throat.  XXXIX.  Diseases  of  the  Breast.  XL.  Hernia.  XLI. 
Special  Herniaa.  XLII.  Diseases  of  Intestinal  Canal.  XLIII.  Diseates  of  Abdominal  Organs, 
and  various  operations  on  the  Abdomen.  XLIV.  Urinary  Calculus.  XLV.  Diseases  of  Bladder 
and  Prostate.  XLVI.  Diseases  of  Urethra.  XLVII.  Diseases  of  Generative  Organs.  INDEX. 


Its  author  has  evidently  tested  the  writings  and 
experiences  of  the  past  aud  present  in  the  crucible 
of  a  careful,  analytic,  and  honorable  mind,  and  faith- 
fully endeavored  to  bring  his  work  up  to  the  level  of 
the  highest  standard  of  practical  surgery.  He  is 
frank  and  definite,  and  gives  us  opinions,  and  gene- 
rally sound  ones,  instead  of  a  mere  resume  of  the 
opinions  of  others.  He  is  conservative,  but  not  hide- 
bound by  authority.  His  style  is  clear,  elegant,  and 
scholarly.  The  work  is  anadmirable  tex-tbook,  and 
a  useful  book  of  reference  It  is  a  credit  to  American 
professional  literature,  and  one  of  the  first  ripe  fruits 
of  the  soil  fertilized  by  the  blood  of  our  late  unhappy 
war.—  N.  Y.  Med.  Record,  Feb.  1, 1S72. 


Indeed,  the  work  as  a  whole  must  be  regarded  aa 
an  excellent  and  concise  exponent  of  modern  sur- 
gery, and  as  such  it  will  be  fouud  a  valuable  text- 
book for  the  student,  and  a  useful  book  of  reference 
for  the  general  practitioner. — N.  Y.  Med.  Journal, 
Feb.  1872. 

It  gives  us  great  pleasure  to  call  the  attention  of  the 
profession  to  this  excellent  work.  Our  knowledge  of 
its  talented  and  accomplished  author  led  us  to  expect 
from  him  a  very  valuable  treatise  upon  subjects  to 
which  he  has  repeatedly  given  evidence  of  having  pro- 
fitably devoted  much  time  and  labor,  and  we  are  in  no 
way  disappointed. —Phila.  Med.  Times,  Feb.  1, 1872. 


pIRRIE  (  WILLIAM],  F.  R.  S.  E., 

J-  Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE  PRINCIPLES  AND  PRACTICE  OF  SURGERY.    Edited  by 

JOHN  NEILL,  M.  D.,  Professor  of  Surgery  in  the  Penna.  Medical  College,  Surgeon  to  the 
Pennsylvania  Hospital,  <tc.  In  one  very  handsome  octavo  volume  of  780  pages,  with  318 
illustrations,  cloth,  $3  75. 


TJAMILTON  (FRANK  H.},  M.D., 

Professor  of  Fractured  and  Dislocations,  Ac.,  in  Bellevue  Hasp.  Med.  College,  New  York. 

A  PRACTICAL  TREATISE   ON  FRACTURES  AND   DISLOCA- 

TIONS.     Fourth  edition,  thoroughly  revised.     In  one  large  and  handsome  octavo  volume 
ol  nearly  800  pages,  with  several  hundred  illustrations.      Cloth,  $5  75;  leather,  $6  75. 


His  not,  of  course,  our  intention  to  review  in  ex- 
Censo,  Hamilton  on  "Fractures  and  Dislocations." 
Eleven  years  ago  such  review  might  not  have  been 
out  of  place ;  to-day  the  work  is  au  authority,  so  well, 
so  generally,  and  so  favorably  known,  that  it  only 
remains  for  the  reviewer  to  say  that  a  new  edition  is 
just  out,  and  it  is  better  than  either  of  its  predeces- 
sors.— Cincinnati  Clinic,  Oct.  14,  1871. 

Undoubtedly  the  best  work  on  Fractures  and  Dis- 
locations in  the  English  language. — Cincinnati  Med. 


Repertory,  Oct.  1871. 


rable  treatise,  which  we  have  always  considered  the 
most  complete  and  reliable  work  on  the  subject.  As 
a  whole,  the  work  is  without  an  equal  in  the  litera- 
ture of  the  profession. — Boston  Med.  and  Burg. 
Journ.,  Oct.  12,  1871. 

It  is  unnecessary  at  this  time  to  commend  the  book, 
except  to  such  as  are  beginners  in  the  study  of  this 
particular  branch  of  surgery.  Every  practical  sur- 
geon in  this  country  and  abroad  knows  of  it  as  a  most 
trustworthy  guide,  and  one  which  they,  in  common 


with  us,  would  unqualifiedly  recommend  as  the  high- 
est authority  in  any  language. — JV.  Y.  Med.  Record, 
We  have  once  more  before  us  Dr.  Hamilton's  admi-  Oct.  16,  1871. 


28 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


f^RICHSEN  (JOHN  E. ), 

•*••  Professor  of  Surgery  in  University  College,  London,  etc. 

THE  SCIENCE  AND  ART  OF  SURGERY;  being  a  Treatise  on  Sur- 

gical  Injuries,  Diseases,  and  Operations.  Revised  by  the  author  from  the  Sixth  and 
enlarged  English  Edition.  Illustrated  by  over  seven  hundred  engravings  on  wood.  In 
two  large  and  beautiful  octavo  volumes  of  over  1700  pages,  cloth,  $9  00  ;  leather,  $11  00. 
(Lately  Issued.) 

Author's  Preface  to  the  New  American  Edition. 

"  The  favorable  reception  with  which  the  '  Science  and  Art  of  Surgery'  has  been  honored  by  the 
Surgical  Profession  in  the  United  States  of  America  has  been  not  only  a  source  of  deep  gratifica- 
tion and  of  just  pride  to  me,  but  has  laid  the  foundation  of  many  professional  friendships  that 
are  amongst  the  agreeable  and  valued  recollections  of  my  life. 

"I  have  endeavored  to  make  the  present  edition  ofthis  work  more  deserving  than  its  predecessors 
of  the  favor  that  has  been  accorded  to  them.     In  consequence  of  delays  that  have  unavoidably 
occurred  in  the  publication  of  the  Sixth  British  Edition,  time  has  been  afforded  to  me  to  add  to  this 
one  several  paragraphs  which  I  trust  will  be  found  to  increase  the  practical  value  of  the  work." 
LONDON,  Oct.  1S72. 

On  no  former  edition  of  this  work  has  the  author  bestowed  more  pains  to  render  it  a  complete  and 
satisfactory  exposition  of  British  Surgery  in  its  modern  aspects.  Every  portion  has  been  sedu- 
lously revised,  and  a  large  number  of  new  illustrations  have  been  introduced.  In  addition  to  the 
material  thus  added  to  the  English  edition,  the  author  has  furnished  for  the  American  edition  such 
material  as  has  accumulated  since  the  passage  of  the  sheets  through  the  press  in  London,  so  that 
the  work  as  now  presented  to  the  American  profession,  contains  his  latest  views  and  experience. 

The  increase  in  the  size  of  the  work  has  seemed  to  render  necessary  its  division  into  two  vol- 
umes. Great  care  has  been  exercised  in  its  typographical  execution,  and  it  is  confidently  pre- 
sented as  in  every  respect  worthy  to  maintain  the  high  reputation  which  has  rendered  it  a  stand- 
ard authority  on  this  department  of  medical  science. 

These  are  only  a  few  of  the  points  in  which  the  i  states  in  his  preface,  they  are  not  confined  to  any  one 
present  edition  of  Mr.  Erichsen's  work  surpasses  its  ;  portion,  but  are  distributed  generally  through  the 
predecessors.  Throughout  there  is  evidence  of  a  subjects  of  which  the  work  treats.  Certainly  one  of 
laborious  care  and  solicitude  in  seizing  the  passing  j  the  most  valuable  sections  of  the  book  seems  to  us  to 
knowledge  of  the  day,  which  reflects  the  greatest  ,  be  that  which  treats  of  the  diseases  of  the  arteries 
credit  on  the  author,  and  much  enhances  the  value  and  the  operative  proceedings  which  they  necessitate 
of  hiswork.  Wecaffonly  admiretheindustry  which  In  few  text-books  is  BO  much  carefully  arranged  in- 
has  enabled  Mr.  Erichsen  thus  to  succeed,  amid  the  !  formation  collected. — London  Med.  Times  and  Gaz., 
distractions  of  active  practice,  in  producing  emphatic-  :  Oct.  26,  1872. 

ally  THE  book  of  reference  and  study  for  British  prac-  j      The  entire  work,  complete,  as  the  great  English 
titioners  of  surgery.— London  Lancet,  Oct.  26,  1872.    i  treatise  on  Surgery  of  our  own  time,  is,  we  can  assure 

Considerable  changes  have  been  made  in  this  edi-    our  readers,  equally  well  adapted  for  the  most  junior 
lion,  and  nearly  a  hundred  new  illustrations  have  '•.  student,  and,  as  a  book  of  reference,  for  the  advanced 
been  added.   Itis  difficultin  a  small  compass  to  point    practitioner. — Dublin  Quarterly  Journal. 
out  the  alterations  and  additions ;  for,  as  the  author  1 


T)RUITT  (EGBERT),  M.R.C.S.,  ire. 

THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY. 

A  new  and  revised  American,  from  the  eighth  enlarged  and  improved  London  edition.  Illus- 
trated with  four  hundred  and  thirty -two  wood  engravings.  In  one  very  handsome  octavo 
volume,  of  nearly  700  large  and  closely  printed  pages,  cloth,  $4  00;  leather,  $5  00. 


All  that  the  surgical  student  or  practitioner  could 
desire. — Dublin  Quarterly  Journal. 

It  is  a  most  admirable  book.  We  do  not  know 
when  we  have  examined  one  with  more  pleasure. — 
Boston  Med.  and  Surg.  Journal. 

In  Mr.  Druitt's  book,  though  containing  only  some 
seven  hundred  pages,  both  the  principles  and  the 


practice  of  surgery  are  treated,  and  so  clearly  and 
perspicuously,  as  to  elucidate  every  important  topic. 
We  have  examined  the  book  most  thoroughly,  and 
can  say  that  this  success  is  well  merited.  His  book, 
moreover,  possesses  the  inestimable  advantages  of 
having  the  subjects  perfectly  well  arranged  and  clas- 
sified, and  of  being  written  in  a  style  at  once  clear 
and  succinct. — Am.  Journal  of  Med.  Sciences. 


A  SET  ON  (T.  J.). 
ON  THE   DISEASES,  INJURIES,  AND  MALFORMATIONS   OF 

THE  RECTUM  AND  ANUS;  with  remarks  on  Habitual  Constipation.  Second  American, 
from  the  fourth  and  enlarged  London  edition.  With  handsome  illustrations.  In  one  very 
beautifully  printed  octavo  volume  of  about  300  pages,  cloth,  $3  25. 


T)IGELO  W  (HENRY  J.),  M.  D., 

•*-*  Professor  of  Surgery  in  the  Massachusetts  Med.  College. 

ON   THE   MECHANISM   OF    DISLOCATION  AND  FRACTURE 

OF  THE  HIP.     With  the  Reduction  of  the  Dislocation  by  the  Flexion  Method.     With 
numerous  original  illustrations.      In  one  very  handsome  octavo  volume.      Cloth,  $2  50. 

TAWSON  (GEORGE),  F.  R.  C.  8.,  Engl, 

J-*  Assistant  Surgeon  to  the  Royal  London  Ophthalmic  Hospital,  Moorflelds,  See. 

INJURIES  OF  THE  EYE,  ORBIT,  AND  EYELIDS:  their  Imme- 

diate  and  Remote  Effects.      With  about  one  hundred  illustrations.     In  one  very  hand- 
some octavo  volume,  cloth,  $3  50 

It  is  an  admirable  practical  book  in  the  highest  and  best  sense  of  the  phrase. — London  Medical  Timei 
and  Gazette,  May  18, 1867. 


HENRY  C.  LEA'S  PUBLICATIONS — (Surgery). 


29 


T>RYANT  (THOMAS),  F.R.C.S., 

•*•'  Surgeon  to  Guy's  Hospital. 

THE   PRACTICE   OF   SURGERY.     With  over  Five  Hundred  En- 

gravings  on  Wood.     In  one  large  and  very  handsome  octavo  volume  of  nearly  1000  pages, 
cloth,  $6  25 ;  leather,  raised  bands,  $7  25.     (Lately  Publislted.) 


Again,  the  author  gives  us  his  own  practice,  his 
own  beliefs,  and  illustrates  by  his  own  cases,  or  those 
treated  in  Guy's  Hospital.  This  feature  adds  joint 
emphasis,  and  a  solidity  to  his  statements  that  inspire 
confidence.  One  feels  himself  almost  by  the  side  of 
the  surgeon,  seeing  his  work  and  hearing  his  living 
words.  The  views,  etc.,  of  other  surgeons  are  con- 
sidered calmly  and  fairly,  but  Mr.  Bryant's  are 
adopted.  Thus  the  work  is  not  a  compilation  of 
other  writings;  it  is  not  an  encyclopaedia,  but  the 
plain  statements,  on  practical  points,  of  a  man  who 
has  lived  and  breathed  and  had  his  being  in  the 
richest  surgical  experience.  The  whole  profession 
owe  a  debt  of  gratitude  to  Mr.  Bryant,  for  his  work 
in  their  behalf.  We  are  confident  that  the  American 
profe.-sion  will  give  substantial  testimonial  of  their 
feelings  towards  both  author  and  publisher,  by 
speedily  exhausting  this  edition.  We  cordially  and 
heartily  commend  it  to  our  friends,  and  think  that 
no  live  surgeon  can  atford  to  be  without  it — Detroit 
Review  of ,  Med.  and  Pharmacy,  August,  1873. 

As  a  manual  of  the  practice  of  surgery  for  the  use 
of  the  student,  we  do  not  hesitate  to  pronounce  Mr. 
Bryant's  book  a  first-rate  work.  Mr.  Bryant  has  a 
good  deal  of  the  dogmatic  energy  which  goes  with 
the  clear,  pronounced  opinions  of  a  man  whose  re- 
flections and  experience  have  moulded  a  character 
not  wanting  in  firmness  and  decision.  At  the  same 
time  he  teaches  with  the  enthusiasm  of  one  who  has 
faith  in  liis  teaching;  he  speaks  as  one  having  au- 
thority, and  herein  lies  the  charm  and  excellence  of 
his  work.  He  states  the  opinions  of  others  freely 


and  fairly,  yet  it  is  no  mere  compilation.  The  book 
combines  much  of  the  merit  of  the  manual  with  the 
merit  of  the  monograph.  One  may  recognize  in 
almost  every  chapter  of  the  ninety-four  of  which  the 
work  is  made  up  the  acuteness  of  a  surgeon  who  has 
seen  much,  and  observed  closely,  and  who  gives  forth 
the  results  of  actual  experience.  In  conclusion  we 
repeat  what  we  stated  at  first,  that  Mr.  Bryant's  book 
is  one  which  we  can  conscientiously  recommend  both 
to  practitioners  and  students  as  an  admirable  work. 
— Dublin  Journ.  of  Med.  Science,  August,  1873. 

Mr.  Bryant  has  long  been  known  to  the  reading 
portion  of  the  profession  as  an  able,  clear,  and  graphic 
writer  upon  surgical  subjects.  The  volume  before 
us  is  one  eminently  upon  the  practice  of  surgery  and 
not  one  which  treats  at  length  on  surgical  pathology, 
though  the  views  that  are  entertained  upon  tnis  sub- 
ject are  sufficiently  interspersed  through  the  work 
for  all  practical  purposes.  As  a  text-book  we  cheer- 
fully recommend  it,  feeling  convinced  that,  from  the 
subject-matter,  and  the  concise  and  true  way  Mr. 
Bryant  deals  with  his  subject,  it  will  prove  a  for- 
midable rival  among  the  numerous  surgical  text- 
books which  are  offered  to  the  student. — If.  Y.  Med. 
Record,  June,  1873. 

This  is,  as  the  preface  states,  an  entirely  new  book, 
and  contains  in  a  moderately  condensed  form  all  the 
surgical  information  necessary  to  a  general  practl-' 
tioner.  It  is  written  in  a  spirit  consistent  with  the 
present  improved  standard  of  medical  and  surgical 
science. — American  Journal  of  Obstetrics,  August, 
1S73. 


WELLS  ( J.  SOELBERG), 

'  '          Professor  of  Ophthalmology  in  King's  College  Hospital,  Ac. 

A  TREATISE  ON  DISEASES  OF  THE  EYE.     Second  American, 

from  the  Third  and  Revised  London  Edition,  with  additions;  illustrated  with  numerous 
engravings  on  wood,  and  six  colored  plates.  Together  with  selections  from  the  Test-types 
of  Jaeger  and  Snellen.  In  one  large  and  very  handsome  octavo  volume  of  nearly  800 
pages  ;  cloth,  $5  00  ;  leather,  $6  00.  (Lately  Published.) 

The  continued  demand  for  this  work,  both  in  England  and  this  country,  is  sufficient  evidence 
that  the  author  has  succeeded  in  his  effort  to  supply  within  a  reasonable  compass  n  full  practical 
digest  of  ophthalmology  in  its  most  modern  aspects,  while  the  call  for  repeated  editions  has  en- 
abled him  in  his  revisions  to  maintain  its  position  abreast  of  the  most  recent  investigations  and 
improvements.  In  again  reprinting  it,  every  effort  has  been  made  to  adapt  it  thoroughly  to  the 
wants  of  the  American  practitioner.  Such  additions  as  seemed  desirable  have  been  introduced 
by  the  editor,  Dr.  I.  Minis  Hays,  and  the  number  of  illustrations  has  been  largely  increased.  The 
importance  of  test-types  as  an  aid  to  diagnosis  is  so  universally  acknowledged  at  the  present  day 
that  it  seemed  essential  to  the  completeness  of  the  work  that  they  should  be  added,  and  as  the 
author  recommends  the  use  of  those  both  of  Jaeger  and  of  Snellen  for  different  purposes,  selec- 
tions have  been  made  from  each,  so  that  the  practitioner  may  have  at  command  all  the  assist- 
ance necessary.  Although  enlarged  by  one  hundred  pages,  it  has  been  retained  at  the  former 
very  moderate  price,  rendering.it  one  of  the  cheapest  volumes  before  the  profession. 
A  few  notices  of  the  previous  edition  are  subjoined. 

On  examining  it  carefully,  one  is  not  at  all  sur-    lucid  and  flowing,  therein  differing  materially  from 
prised  that  it  should  meet  with  universal  favor.     It  j  souieof  the  translations  of  Continental  writers  on  this 


is,  in  fact,  a  comprehensive  and  thoroughly  practical 
treatise  on  diseases  of  the  eye,  setting  forth  the  prac- 
tice of  the  leading  oculists  of  Europe  and  America, 
ami  giving  the  author's  own  opinions  and  preferences, 
which  are  quite  decided  and  worthy  of  high  consid- 
eration. The  third  English  edition,  from  which  this 
is  taken,  having  been  revised  by  the  author,  com- 
prises a,  notice  of  all  the  more  recent  advances  made 
in  ophthalmic  science.  The  style  of  the  writer  is 


ubject  that  are  in  the  market.  Special  pains  are 
taken  to  explain,  at  length,  those  subjects  which  are 
particularly  difficult  of  comprehension  to  the  begin- 
uer,  as  the  use  of  the  ophthalmoscope,  the  interpre- 
tation of  its  images,  etc.  The  book  is  profusely  and 
ably  illustrated,  and  at  the  end  are  to  be  found  16 
excellent  colored  ophthalmoscopic  figures,  which  are 
copies  of  some  of  the  plates  of  Liebreich's  admirable 
atlas.—  Kansas  City  Med.  Journ.,  June,  1874. 


/  A  URENCE  (JOHN  Z.),  F.  R.  C.  S., 

"^  Editor  of  the  Ophthalmic  Review,  &c. 

A  HANDY-BOOK  OF   OPHTHALMIC   SURGERY,  for  the  use  of 

Practitioners.     Second  Edition,  revised  and  enlarged.     With  numerous  illustrations.     In 
one  very  handsome  octavo  volume,  cloth,  $3  00. 
For  those,  however,  who  must  assume  the  care  of    edition  those  novelties  which  have  secured  the  confl- 


diseases  and  injuries  of  the  eye,  and  who  are  too 
much  pressed  for  time  to  study  the  classic  works  on 
the  subject,  or  those  recently  published  by  Stellwag, 
Wells,  Bader,  and  others,  Mr.  Laurence  will  prove  a 
safe  and  trustworthy  guide.  He  has  described  in  thlt 


dence  of  the  profession  since  the  appearance  of  hi 
last.     The  volume  has  been  considerably  enlarged 
and  improved  by  the  revision  and  additions  of  its 
author,  expressly  for  the   American  edition. — Am. 
Journ.  Med.  Sciences,  Jan.  1870. 


1 
30  HENRY  C.  LEA'S  PUBLICATIONS — (Surgery,  &c.). 


THOMPSON  (SIR  HENRY), 

•*•  Surgeon  and  Professor  of  Clinical  Surgery  to  University  College  Hospital. 

LECTURES  ON  DISEASES  OF  THE  URINARY  ORGANS.   With 

illustrations  on  wood.  Second  American  from  the  Third  English  Edition.  In  one  neat 
octavo  volume.  Cloth,  $225.  (Now  Ready.) 

My  aim  has  been  to  produce  in  the  smallest  possible  compass  an  epitome  of  practical  knowl- 
edge concerning  the  nature  and  treatment  of  the  diseases  which  form  the  subject  of  the  work  ; 
and  I  venture  to  believe  that  my  intention  has  been  more  fully  realized  in  this  volume  than  in 
either  of  its  predecessors. — Autlwr^s  Preface. 

TOY  THE  SAME  AUTHOR. 

ON  THE  PATHOLOGY  AND  TREATMENT  OF  STRICTURE  OF 

THE  URETHRA  AND  URINARY  FISTULA.  With  plates  and  wood-cuts.  From  the 
third  and  revised  English  edition.  In  one  very  handsome  octavo  volume,  cloth,  $3  50. 
(Lately  Published.) 

TOY  THE  SAME  AUTHOR.     (Just  Issued.) 

THE  DISEASES   OF   THE  PROSTATE,  THEIR   PATHOLOGY 

AND  TREATMENT.  Fourth  Edition,  Revised.  In  one  very  handsome  octavo  volume  of 
355  pages,  with  thirteen  piates,  plain  and  colored,  and  illustrations  on  wood.  Cloth,  $3  75. 

rFAYLOR  (ALFRED  S.),  M.D., 

•*•  Lecturer  on  Med.  Jurisp.  and  Chemistry  in  Quy's  Hospital 

MEDICAL  JURISPRUDENCE.     Seventh  American  Edition.     Edited 

by  JOHN  J.  REESE,  M.D.,  Prcf.  of  Med.  Jurisp.  in  the  Univ.  of  Penn.  In  one  large 
octavo  volume  of  nearly  900  pages.  Cloth,  $5  00;  leather,  $6  00.  (Just  Issued.) 

In  preparing  for  the  press  this  seventh  American  edition  of  the  "  Manual  of  Medical  Jurispru- 
dence" the  editor  has,  through  the  courtesy  of  Dr.  Taylor,  enjoyed  the  very  great  advantage  of 
consulting  the  sheets  of  the  new  edition  of  the  author's  larger  work,  "  The  Principles  and  Prac- 
tice of  Medical  Jurisprudence,"  which  is  now  ready  for  publication  in  London.  This  has  enabled 
him  to  introduce  the  author's  latest  views  upon  the  topics  discussed,  which  are  believed  to  bring 
the  work  fully  up  to  the  present  time. 

The  notes  of  the  former  editor,  Dr.  Hartshorne,  as  also  the  numerous  valuable  references  to 
American  practice  and  decisions  by  his  successor,  Mr.  Penrose,  have  been  retained,  with  but  few 
slight  exceptions ;  they  will  be  found  inclosed  in  brackets,  distinguished  by  the  letters  (H.)  and 
(P.).  The  additions  made  by  the  present  editor,  from  the  material  at  his  command,  amount  to 
about  one  hundred  pages;  and  his  own  notes  are  designated  by  the  letter  (R.). 

Several  subjects,  not  treated  of  in  the  former  edition,  have  been  noticed  in  the  present  one, 
and  the  work,  it  is  hoped,  will  be  found  to  merit  a  continuance  of  the  confidence  which  it  has  so 
long  enjoyed  as  a  standard  authority. 

TOY  THE  SAME  AUTHOR.     (Now  Ready.) 

THE  PRINCIPLES  AND  PRACTICE  OF  MEDICAL  JURISPRU- 

DENCE.     Second  Edition,  Revised,  with  numerous  Illustrations.     In  two  large  octavo 

volumes,  cloth,  $10  00;  leather,  $12  00, 

This  great  work  is  now  recognized  in  England  as  the  fullest  and  most  authoritative  treatise  on 
every  department  of  its  important  subject.  In  laying  it,  in  ita  improved  form,  before  the  Ameri- 
can profession,  the  publisher  trusts  that  it  will  assume  the  same  position  in  this  country. 

J^Y  THE  SAME  AUTHOR.    New  Edition— Nearly  Ready. 

POISONS  IN  RELATION  TO  MEDICAL  JURISPRUDENCE  AND 

MEDICINE.  Third  American,  from  the  Third  and  Revised  English  Edition.  In  one 
large  octavo  volume  of  860  pages. 

This  work,  which  has  been  so  long  recognized  as  a  leading  authority  on  its  important  subject, 
has  received  a  very  thorough  revision  at  the  hands  of  the  author,  and  may  be  regarded  as  * 
new  book  rather  than  as  a  mere  revision.  He  has  sought  to  bring  it  on  all  points  to  a  level 
with  the  advanced  science  of  the  day;  many  portions  have  been  rewritten,  much  that  was  of 
minor  importance  has  been  omitted,  and  every  effort  made  to  condense  a  complete  view  of  the 
subject  within  the  limits  of  a  single  volume.  Dr.  Taylor's  position  as  an  expert  has  brought 
him  into  connection  with  nearly  all  important  cases  in  England  for  many  years.  He  thus  speaks 
with  an  authority  that  few  other  living  men  possess,  while  his  intimate  acquaintance  with  the 
literature  of  toxicology  on  both  sides  of  the  Atlantic,  renders  his  work  equally  adapted  as  a 
text-book  in  this  country  as  in  Great  Britain. 


tn.uu» — iuBiainu  irriiauuB — v  egeiaoie  irritants — Animal  Irritant*. 

Neurotic  Poisons. — Cerebral  or  Narcotic  Poisons— Spinal  Poisons — Cerebro-Spinal  Poisons — 
Cerebro-Cardiac  Poisons. 


HENRY  C.  LEA'S  PUBLICATIONS  —  (Psychological  Medicine,  &c.).      31 


(DANIEL  HACK),  M.D., 

J-  Joint  author  of  "  The  Manual  of  Psychological  Mtdicine,"  Ac. 

ILLUSTRATIONS  OF  THE  INFLUENCE  OF  THE  MIND  UPON 

THE  BODY  IN  HEALTH  AND  DISEASE.      Designed  to  illustrate  the  Action  of  the 

Imagination.     In  .one  handsome  octavo  volume  of  416  pages,  cloth,  $3  25.     (Just  Issued.) 

The  object  of  the  author  in  this  work  has  been  to  show  not  only  the  effect  of  the  mind  in  caus- 

ing and  intensifying  disease,  but  also  its  curative  influence,  and  the  use  which  may  be  made  of 

the  imagination  and  the  emotions  as  therapeutic  agents.     Scattered  facts  hearing  upon  this  sub- 

ject have  long  been  familiar  to  the  profession,  but  no  attempt  has  hitherto  been  made  to  collect 

and  systematize  them  so  as  to  render  them  available  to  the  practitioner,  by  establishing  the  seve- 

ral phenomena  upon  a  scientific  basis.     In  the  endeavor  thus  to  convert  to  the  use  of  legitimate 

medicine  the  means  which  have  been  employed  so  successfully  in  many  systems  of  quackery,  the 

author  has  produced  a  work  of  the  highest  freshness  and  interest  as  well  as  of  permanent  value. 


JZLANDFORD  (G.  FIELDING],  M.  D.,  F.  R.C  P., 

J-*  Lecturer  on  Psychological  Medicine  at  the  School  of  St.  George's  Hospital,  Ac. 

INSANITY  AND  ITS  TREATMENT:  Lectures  on  the  Treatment, 

Medical  and  Legal,  of  Insane  Patients.  With  a  Summary  of  the  Laws  in  force  in  the 
United  States  on  the  Confinement  of  the  Insane.  By  ISAAC  RAY,  M.  D.  In  one  very 
handsome  octavo  volume  of  471  pages;  cloth,  $3  25. 

This  volume  is  presented  to  meet  the  want,  so  frequently  expressed,  of  a  comprehensive  trea- 
tise, in  moderate  compass,  on  the  pathology,  diagnosis,  and  treatment  of  insanity.  To  render  it  of 
more  value  to  the  practitioner  in  this  country,  Dr.  Ray  has  added  an  appendix  which  affords  in- 
formation, not  elsewhere  to  be  found  in  so  accessible  a  form,  to  physicians  who  may  at  any  moment 
be  called  upon  to  take  action  in  relation  to  patient*. 

It  satisfies  a  want  which  mast  have  been  sorely  actually  seen  in  practice  and  the  appropriate  treat- 
felt  by  the  busy  general  practitioners  of  this  country,  i  ment  for  them,  we  find  in  Dr.  Blandford's  work  a 
It  takes  the  form  of  a  manual  of  clinical  description  {  considerable  advance  over  previous  writings  on  the 


of  the  various  forms  of  insanity,  with  a  description 
of  the  mode  of  examining  persons  suspected  of  in- 
sanity. We  call  particular  attention  to  this  feature 
of  the  book,  as  giving  it  a  unique  value  to  the  gene- 
ral practitioner.  If  we  pass  from  theoretical  conside- 
rations to  descriptions  of  the  varieties  of  insanity  as 


subject.  His  pictures  of  the  various  forms  of  mental 
disease  are  so  clear  and  good  that  no  reader  can  fail 
to  be  struck  with  their  superiority  to  those  given  in 
ordinary  manuals  in  the  English  language  or  (so  far 
as  our  own  reading  extends)  in  any  other. — London 
Practitioner,  Feb.  1871. 


W: 


'INSLOW  (FORBES),  M.D.,  D.C.L.,  £c. 

ON  OBSCURE  DISEASES  OF  THE  BRAIN  AND  DISORDERS 

OF  THE  MIND;  their  incipient  Symptoms,  Pathology,  Diagnosis,  Treatment,  and  Pro- 
phylaxis. Second  American,  from  the  third  and  revised  English  edition.  In  one  handsome 
octavo  volume  of  nearly  600  pages,  cloth,  $4  25. 


TEA  (HENRY  C.). 

SUPERSTITION    AND    FORCE:    ESSAYS    ON    THE   WAGER   OF 

LAW,  THE  WAGER  OF  BATTLE,  THE  ORDEAL,  AND  TORTURE.  Second  Edition, 
Enlarged.  In  one  handsome  volume  royal  12mo.  of  nearly  500  pages;  cloth,  $2  75. 
(Lately  Published.) 

We  know  of  no  single  work  which  contains,  in  so  r  interesting  phases  of  human  society  and  progress.  .  . 
•mall  a  compass,  so  much  illustrative  of  the  strangest  j  The  fulness  and  breadth  with  which  he  has  carried 
operations  of  the  human  mind.  Foot-notes  give  the  i  out  his  comparative  survey  of  this  repulsive  field  of 
authority  for  each  statement,  showing  vast  research  !  history  [Torture],  are  such  as  to  preclude  our  doing 
and  wonderful  industry.  We  advise  our  con/reret  justice  to  the  work  within  our  present  limits.  But 
to  read  this  book  and  ponder  its  teachings. — Chicago  \  here,  as  throughout  the  volume,  there  will  be  found 
Mt.d.  Journal,  Aug.  1S70.  I  a  wealth  of  illustration  and  a  critical  grasp  of  the 

As  a  work  of  curious  inquiry  on  certain  outlying  |  Philosophical  import  of  facts  which  will  render  Mi. 
pints  of  obsolete  law,  "Superstition  and  Force"  is  i  Lea  8  labors  of  «erli«g  value  to  the  historical  «tn- 


points  of  obsolete  law,  "Superstiti 

one  of  the  most  remarkable  books  we  have  met  with. 

—London  JLthenceum,  Nov.  3,  1866. 

He  has  thrown  a  great  deal  of  light  upon  what  must 
be  regarded  as  one  of  the  most  instructive  as  well  as 


dent. — London  Saturday  Review,  Oct.  S,  1870. 

As  a  book  of  ready  reference  on  the  subject,  it  is  of 
the  highest  value. —  Westminster  Review,  Oct.  1867. 


l7  THE  SAME  AUTHOR.    (Lately  Published.) 

STUDIES  IN  CHURCH  HISTORY— THE  RISE  OF  THE  TEM- 
PORAL POWER— BENEFIT  OF  CLERGY^EXCOMMUNICATION.  In  one  large  royal 
12mo.  volume  of  516  pp.  cloth,  $2  75. 


The  story  was  never  told  more  calmly  or  with 
greater  learning  or  wiser  thought.  We  doubt,  indeed, 
If  any  other  study  of  this  field  can  be  compared  with 
this  for  clearness,  accuracy,  and  power.  —  Chicago 
Examiner,  Dec.  1870. 

Mr.  Lea' s  latest  work,  "Studies  in  Church  History," 
fully  sustains  the  promise  of  the  first.  It  deals  with 
three  subjects — the  Temporal  Power,  Benefit  of 
Clergy,  and  Excommunication,  the  record  of  which 
has  a  peculiar  importance  for  the  English  student,  and 
is  a  chapter  on  Ancient  Law  likely  to  be  regarded  as 
final.  We  can  hardly  pass  from  our  mention  of  such 


literary  phenomenon  that  the  head  of  one  of  the  first 
American  bouses  in  also  the  writer  of  some  of  its  most 
original  books. — London  Atkt>n<eum,  Jan.  7,  1871. 

Mr.  Lea  has  done  great  honor  to  himself  and  this 
country  by  the  admirable  works  he  has  written  on 
ecclesiologioal and  cognate  *ubj  ects.  We  have  already 
had  occasion  to  command  his  "Superstition  and 
Force"  and  his  "History  of  Sacerdotal  Celibacy." 
The  present  volume  is  fully  as  admirable  in  its  me- 
thod of  dealing  with  topics  and  in  the  thoroughness— 
a  quality  so  frequently  lacking  in  American  authors — 
with  which  they  are  investigated. — N.  Y.  Journal  of 


works  as  these — with  which  that  on    "Sacerdotal    Psyohol.  Medicine,  July,  1870. 
Celibacy"  should  be  included — without  noting  the  I 


INDEX    TO    CATALOGUE. 


PAGE 

.  1 

.  3 

.  6 

.  20 

.  28 

.  10 

.  23 

.  27 

.  23 
7 

.  29 

.  11 

.  31 

.  18 

.  17 

.  28 

.  14 

.  11 

.  il 

.  19 

.  19 


American  Journal  of  the  Medical  Sciences 
Abstract,  Half-Yearly,  of  the  Med.  Sciences 
Anatomical  Atlas,  by  Smith  and  Homer 
Anderson  on  Diseases  of  the  Skin 
Ashton  on  the  Rectum  and  Anns  .        .        . 

Attfleld's  Chemistry 

Ashwell  on  Diseases  of  Females  . 

Ashhurst's  Surgery 

Barnes  on  Diseases  of  Women       .       .       . 

Bellamy's  Surgical  Anatomy 

Bryant's  Practical  Surgery    .... 

Bloxam's  Chemistry  .       .        . 

Blandford  on  Insanity    .        . 

Basham  on  Renal  Diseases     .... 

Brinton  on  the  Stomach          .... 

Bigelow  on  the  Hip          .... 

Barlow's  Practice  of  Medicine 

Bowman's  (John  E.)  Practical  Chemistry    . 

Bowman's  (John  E.)  Medical  Chemistry 

Bnmstead  on  Venereal 

Bumstead  and  Cnllerier's  Atlas  of  Venereal 
Carpenter's  Human  Physiology  . 
Carpenter's  Comparative  Physiology  ...  8 
Carpenter  on  the  Use  and  Abuse  of  Alcohol  .  13 
Carson's  Synopsis  of  Materia  Medica  .  .  .13 
Chambers  on  Diet  and  Regimen  .  .  .  .16 
Chambers  on  the  Indigestions  ...  16 

Chambers's  Restorative  Medicine  .  .  '  16 
Christison  and  Griffith's  Dispensatory  .  "  13 
Churchill's  System  of  Midwifery  .  .  .  '25 
Churchill  on  Puerperal  Fever  .  .  .  '23 
Condie  on  Diseases  of  Children  .  .  .  '  21 
Cooper's  (B.  B.)  Lectures  on  Surgery  .  .  '26 
Cnllerier's  Atlas  of  Venereal  Diseases  .  *  19 
Cyclopedia  of  Practical  Medicine  .  .  .  '  15 
Dalton's  Human  Physiology  .  .  '  9 

Davis'  Clinical  Lectures  .  .  .  .  •  14 
De  Jongh  on  Cod-Liver  Oil  .  .  .  .  -13 
Dewees  on  Diseases  of  Females  •  23 

Dewees  on  Diseases  of  Children  .  .  .  -20 
Druitt's  Modern  Surgery  •  28 

Dunglison's  Medical  Dictionary  .  .  .  •  4 
Dunglison's  Human  Physiology  .  •  9 

Dnnglison  on  New  Remedies  .  .  .  -13 
Ellis's  Medical  Formulary,  by  Smith  .  .  -13 
Erichsen's  System  of  Surgery  .  .  .  •  28 

Fenwick's  Diagnosis -14 

Flint  on  Respiratory  Organs  .....    17 

Flint  on  the  Heart *'W 

Flint's  Practice  of  Medicine 15 

Flint's  Essays -15 

Fownes's  Elementary  Chemistry  .  .  .  .10 
Fox  on  Diseases  of  the  Stomach  .  .  .  -17 

Fulleron   the  Lungs,  &c -17 

Green's  Pathology  and  Morbid  Anatomy     .        •     14 

Gibson's  Surgery .26 

G  luge's  Pathological  Histology,  by  Leidy  .  •  14 
Galloway's  Qualitative  Analysis .  .  .  10 

Gray's  Anatomy 6 

Griffith's  (R.  E.)  Universal  Formulary  .  ".>JW 
Gross  on  Foreign  Bodies  in  Air-Passages  .  .  26 
Gross's  Principles  and  Practice  of  Surgery  .  .  26 
Guersant  on  Surgical  Diseases  of  Children  .  .'  » 
Hamilton  on  Dislocations  and  Fractures  .  •_ _j? 
Hartshorne's  Essentials  of  Medicine  .  .  i?-W- 
Hartshorne's  Conspectus  of  the  Medical  Sciences  5 
Hartshorne's  Anatomy  and  Physiology  .  .  7 

Heath's  Practical  Anatomy 7 

Hoblyn's  Medical  Dictionary        .  "* ''."'".•"""*."  %V 

Hodge  on  Women 23 

Hodge's  Obstetrics 24 

Hodges'  Practical  Dissections  ....  6 
Holland's  Medical  Notes  and  Reflections  .  .  14 
Homer's  Anatomy  and  Histology  ...  6 

Hudson  on  Fevers 18 

Hill  on  Venereal  Diseases 19 

Hillier's  Handbook  of  Skin  Diseases  .        .     20 

Jones  and  Sieveking's  Pathological  Anatomy  .  14 
Jones  (C.  Handfleld)  on  Nervous  Disorders  .  18 


Kirkes'  Physiology         .... 

Knapp's  Chemical  Technology     ... 

Lea's  Superstition  and  Force 

Lea's  Studies  in  Church  History    . 

Lee  on  Syphilis 

Lincoln  on  Electro-Therapeutics    . 

Leishman's  Midwifery    .        .        .        .        . 

La  Roche  on  Yellow  Fever    . 

La  Roche  on  Pneumonia,  &c.         . 
I  Laurence  and  Moon's  Ophthalmic  Surgery   . 
|  Lawson  on  the  Eye          .        .        . 
i  Laycock  on  Medical  Observation  . 
|  Lehmann's  Physiological  Chemistry,  2  vols. 
i  Lehmann's  Chemical  Physiology  . 
1  Ludlow's  Manual  of  Examinations       .        . 

Lyons  on  Fever 

Maclise's  Surgical  Anatomy 

Marshall's  Physiology 

Medical  News  and  Library    . 

Meigs's  Lectures  on  Diseases  of  Women 

Meigs  on  Puerperal  Fever 

Miller's  Practice  of  Surgery 

Miller's  Principles  of  Surgery       . 

Montgomery  on  Pregnancy   . 

Neil!  and  Smith's  Compendium  of  Med.  Science  . 

Neligan's  Atlas  of  Diseases  of  the  Skin 

Neligan  on  Diseases  of  the  Skin    . 

Obstetrical  Journal 

Odling's  Practical  Chemistry       . 

Pavy  on  Digestion 

Pavy  on  Food 

Parrish's  Practical  Pharmacy       .        .        .        . 

Pirrie's  System  of  Surgery 

Pereira's  Mat.  Medica  and  Therapeutics,  abridged 

Quain  and  Sharpey's  Anatomy,  by  Leidy    . 

Roberts  on  Urinary  Diseases 

Ramsbotham  on  Parturition 

Rigby's  Midwifery 

Royle's  Materia  Medica.and  Therapeutics    . 

Swayne's  Obstetric  Aphorisms  . 

Sargent's  Minor  Surgery 

Sharpey  and  Quain's  Anatomy,  by  Leidy    . 

Skey's  Operative  Surgery 

Slade  on  Diphtheria 

Smith  (J.  L.)  on  Children 

Smith  (H.  H.)  and  Horner's  Anatomical  Atlas      . 

Smith  (Edward)  on  Consumption  . 

Smith  on  Wasting  Diseases  ».  Children 

Still6's  Therapeutics 

Sturges  on  Clinical  Medicine         .... 

Stokes  on  Fever 

Tanner's  Manual  of  Clinical  Medicine  . 
Tanner  on  Pregnancy     .  ... 

Taylor's  Medical  Jurisprudence     .... 
Taylor's  Principles  and  Practice  of  Med   Jurisp 

Taylor  on  Poisons 

Tuke  on  the  Influence  of  the  Mind 

Thomas  on  Diseases  of  Females    .... 

Thompson  on  Urinary  Organs        .... 

Thompson  on  Stricture 

Thompson  on  the  Prostate 

Todd  on  Acute  Diseases  ...... 

Walshe  on  the  Heart 

Watson's  Practice  of  Physic 

Wells  on  the  Eye 

West  on  Diseases  of  Females         .... 
West  on  Diseases  of  Children        .        .        .        . 
West  on  Nervous  Disorders  of  Children 
What  to  Observe  in  Medical  Cases        .        . 
Williams  on  Consumption     .        ^-^v^.QBW     -t 

Wilson  s  Human  Anatomy 

Wilson  on  Diseases  of  the  Skin     .... 
Wilson's  Plates  on  Diseases  of  the  Skin      .        , 
Wilson's  Handbook  of  Cutaneous  Medicine         . 
Winslow  on  Brain  and  Mind         »  i  .t»p'J  ,-s».«i«vin 
Wohler's  Organic  Chemistry         .     ,,,*.',.,.  i  ,i 

Winckel  on  Childbed 

Zeissl  on  Venereal 


PAOB 

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6 

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8 

.  2 
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,  23 
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For  "THE  OBSTETRICAL  JOURNAL,"  FIVE  DOLLARS  a  year,  see  p.  22. 


Date  Due 


IAR  0 

tftR-8- 


1978 
-RECU 


PRINTED   IN   U.S.*.  CAT.      NO.     24      161 


UC  SOUTHERN  REGIONAL  LIBRARY  FAC 


A  000416962  9 


WBUOO 


1875 
Chambers,  Thomas  King. 

A  manual  of  diet  in  health  and 
disease 


WBUOO 


1875 

Chambers,  Thomas  King. 

A  manual  of  diet  in  health  and  iisease 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 
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